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Jahangiri M, Prendergast B. Management of bicuspid aortic valve disease in the transcatheter aortic valve implantation era. Heart 2024:heartjnl-2024-324054. [PMID: 39117383 DOI: 10.1136/heartjnl-2024-324054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Accepted: 07/23/2024] [Indexed: 08/10/2024] Open
Abstract
In an era of rapidly expanding use of transcatheter aortic valve implantation (TAVI), the management of patients with bicuspid aortic valve (BAV) disease is far less well established than in those with trileaflet anatomy. Results of isolated surgical aortic valve replacement are excellent in suitable patients, and surgery also allows treatment of concomitant pathology of the aortic root and ascending aorta that is frequently encountered in this cohort. Conversely, TAVI provides an excellent alternative in older patients who may be unsuitable for surgery, although outcomes in BAV disease have only been reported in relatively small non-randomised series. Here, we discuss the pertinent literature on this topic and outline contemporary interventional treatment options in this challenging setting.
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Affiliation(s)
- Marjan Jahangiri
- Department of Cardiac Surgery, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Bernard Prendergast
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Schnackenburg P, Saha S, Ali A, Horke KM, Buech J, Mueller CS, Sadoni S, Orban M, Kaiser R, Doldi PM, Rizas K, Massberg S, Hagl C, Joskowiak D. Failure of Surgical Aortic Valve Prostheses: An Analysis of Heart Team Decisions and Postoperative Outcomes. J Clin Med 2024; 13:4461. [PMID: 39124728 PMCID: PMC11312932 DOI: 10.3390/jcm13154461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Revised: 07/23/2024] [Accepted: 07/27/2024] [Indexed: 08/12/2024] Open
Abstract
Objectives: To analyze Heart Team decisions and outcomes following failure of surgical aortic valve replacement (SAVR) prostheses. Methods: Patients undergoing re-operations following index SAVR (Redo-SAVR) and those undergoing valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) following SAVR were included in this study. Patients who underwent index SAVR and/or Redo-SAVR for endocarditis were excluded. Data are presented as medians and 25th-75th percentiles, or absolute numbers and percentages. Outcomes were analyzed in accordance to the VARC-3 criteria. Results: Between 01/2015 and 03/2021, 53 patients underwent Redo-SAVR, 103 patients ViV-TAVR. Mean EuroSCORE II was 5.7% (3.5-8.5) in the Redo-SAVR group and 9.2% (5.4-13.6) in the ViV group. In the Redo-SAVR group, 12 patients received aortic root enlargement (22.6%). Length of hospital and ICU stay was longer in the Redo-SAVR group (p < 0.001; p < 0.001), PGmax and PGmean were lower in the Redo-SAVR group as compared to the ViV-TAVR group (18 mmHg (10-30) vs. 26 mmHg (19-38), p < 0.001) (9 mmHg (6-15) vs. 15 mmHg (9-21), p < 0.001). A higher rate of paravalvular leakage was seen in the ViV-TAVR group (p = 0.013). VARC-3 Early Safety were comparable between the two populations (p = 0.343). Survival at 1 year and 5 years was 82% and 36% in the ViV-TAVR cohort and 84% and 77% in the Redo-SAVR cohort. The variables were patient age (OR 1.061; [95% CI 1.020-1.104], p = 0.004), coronary heart disease (OR 2.648; [95% CI 1.160-6.048], p = 0.021), and chronic renal insufficiency (OR 2.711; [95% CI 1.160-6.048], p = 0.021) showed a significant correlation to ViV-TAVR. Conclusions: Heart Team decisions are crucial in the treatment of patients with degenerated aortic bioprostheses and lead to a low mortality in both treatment paths thanks to patient-specific therapy planning. ViV-TAVR offers a treatment for elderly or intermediate-risk profile patients with comparable short-term mortality. However, this therapy is associated with increased pressure gradients and a high prevalence of paravalvular leakage. Redo-SAVR enables the surgical treatment of concomitant cardiac pathologies and allows anticipation for later VIV-TAVR by implanting the largest possible valve prostheses.
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Affiliation(s)
- Philipp Schnackenburg
- Department of Cardiac Surgery, LMU University Hospital, Marchioninistrasse 15, 81377 Munich, Germany (S.S.)
- German Centre for Cardiovascular Research (DZHK), Partner site Munich Heart Alliance, 80802 Munich, Germany
| | - Shekhar Saha
- Department of Cardiac Surgery, LMU University Hospital, Marchioninistrasse 15, 81377 Munich, Germany (S.S.)
- German Centre for Cardiovascular Research (DZHK), Partner site Munich Heart Alliance, 80802 Munich, Germany
| | - Ahmad Ali
- Department of Cardiac Surgery, LMU University Hospital, Marchioninistrasse 15, 81377 Munich, Germany (S.S.)
- German Centre for Cardiovascular Research (DZHK), Partner site Munich Heart Alliance, 80802 Munich, Germany
| | - Konstanze Maria Horke
- Department of Cardiac Surgery, LMU University Hospital, Marchioninistrasse 15, 81377 Munich, Germany (S.S.)
- German Centre for Cardiovascular Research (DZHK), Partner site Munich Heart Alliance, 80802 Munich, Germany
| | - Joscha Buech
- Department of Cardiac Surgery, LMU University Hospital, Marchioninistrasse 15, 81377 Munich, Germany (S.S.)
- German Centre for Cardiovascular Research (DZHK), Partner site Munich Heart Alliance, 80802 Munich, Germany
| | - Christoph S. Mueller
- Department of Cardiac Surgery, LMU University Hospital, Marchioninistrasse 15, 81377 Munich, Germany (S.S.)
- German Centre for Cardiovascular Research (DZHK), Partner site Munich Heart Alliance, 80802 Munich, Germany
| | - Sebastian Sadoni
- Department of Cardiac Surgery, LMU University Hospital, Marchioninistrasse 15, 81377 Munich, Germany (S.S.)
- German Centre for Cardiovascular Research (DZHK), Partner site Munich Heart Alliance, 80802 Munich, Germany
| | - Martin Orban
- Department of Cardiology, LMU University Hospital and German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Marchioninistrasse 15, 81377 Munich, Germany
| | - Rainer Kaiser
- Department of Cardiology, LMU University Hospital and German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Marchioninistrasse 15, 81377 Munich, Germany
| | - Philipp Maximilian Doldi
- Department of Cardiology, LMU University Hospital and German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Marchioninistrasse 15, 81377 Munich, Germany
| | - Konstantinos Rizas
- Department of Cardiology, LMU University Hospital and German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Marchioninistrasse 15, 81377 Munich, Germany
| | - Steffen Massberg
- Department of Cardiology, LMU University Hospital and German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Marchioninistrasse 15, 81377 Munich, Germany
| | - Christian Hagl
- Department of Cardiac Surgery, LMU University Hospital, Marchioninistrasse 15, 81377 Munich, Germany (S.S.)
- German Centre for Cardiovascular Research (DZHK), Partner site Munich Heart Alliance, 80802 Munich, Germany
| | - Dominik Joskowiak
- Department of Cardiac Surgery, LMU University Hospital, Marchioninistrasse 15, 81377 Munich, Germany (S.S.)
- German Centre for Cardiovascular Research (DZHK), Partner site Munich Heart Alliance, 80802 Munich, Germany
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Myon F, Marut B, Kosmala W, Auffret V, Leurent G, L'official G, Curtis E, Le Breton H, Oger E, Donal E. Transcatheter aortic valve implantation in severe aortic stenosis does not necessarily reverse left ventricular myocardial damage: data of long-term follow-up. Eur Heart J Cardiovasc Imaging 2024; 25:821-828. [PMID: 38236150 DOI: 10.1093/ehjci/jeae017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 12/28/2023] [Accepted: 12/29/2023] [Indexed: 01/19/2024] Open
Abstract
AIMS Aortic stenosis (AS) is causing myocardial damage and replacement is mainly indicated based on symptoms. Non-invasive estimation of myocardial work (MW) provides a less afterload-dependent too for assessing myocardial function. We sought to look at the impact of transcatheter aortic valve implantation (TAVI) on the myocardium at long-term follow-up and according to current indications. METHODS AND RESULTS We conducted an observational, cross-sectional, single-centre study. Patients were selected based on the validated indication for a TAVI. Standardized echocardiographies were repeated. A total of 102 patients were included. The mean age was 85 years, 45% were female, 68% had high blood pressure, and 52% had a coronary disease. One-fifth was suffering from low-flow-low-gradient AS. A follow-up was performed at 22 ± 9.5 months after the TAVI. No TAVI dysfunction was observed. Left ventricular (LV) ejection fraction was stable (62 ± 8%), and global longitudinal strain had improved (-14.0 ± 3.7 vs. -16.0 ± 3.6%, P < 0.0001). No improvement of the MW parameters was noticed (LV global work index 2099 ± 692 vs. 2066 ± 706 mmHg%, P = 0.8, LV global constructive 2463 ± 736 vs. 2463 ± 676 mmHg%, P = 0.8). Global wasted work increased [214 (149; 357) vs. 247 (177; 394) mmHg%, P = 0.0008]. CONCLUSION In a population of severe symptomatic AS patients who had undergone a TAVI, the non-invasive myocardial indices that assess the LV performance at long-term follow-up did not improve. These results are questioning the timing of the intervention and the need for more attention in the pharmacological management of these AS patients.
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Affiliation(s)
- Frederic Myon
- Cardiologie, CHU de RENNES, LTSI UMR1099, INSERM, Université de Rennes, Rennes, France
| | - Benjamin Marut
- Cardiologie, CHU de RENNES, LTSI UMR1099, INSERM, Université de Rennes, Rennes, France
| | | | - Vincent Auffret
- Cardiologie, CHU de RENNES, LTSI UMR1099, INSERM, Université de Rennes, Rennes, France
| | - Guillaume Leurent
- Cardiologie, CHU de RENNES, LTSI UMR1099, INSERM, Université de Rennes, Rennes, France
| | - Guillaume L'official
- Cardiologie, CHU de RENNES, LTSI UMR1099, INSERM, Université de Rennes, Rennes, France
| | - Elizabeth Curtis
- Cardiologie, CHU de RENNES, LTSI UMR1099, INSERM, Université de Rennes, Rennes, France
| | - Herve Le Breton
- Cardiologie, CHU de RENNES, LTSI UMR1099, INSERM, Université de Rennes, Rennes, France
| | - Emmanuel Oger
- EA Reperes, CHU Rennes, University of Rennes, Rennes, France
| | - Erwan Donal
- Cardiologie, CHU de RENNES, LTSI UMR1099, INSERM, Université de Rennes, Rennes, France
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Pinar Abellán Á, López Vázquez M, Vallejo Calcerrada N, Gallardo López A, Jiménez Mazuecos J, Melehi El Assali D. Acute transcatheter aortic prosthesis dysfunction with severe regurgitation secondary to spontaneous leaflet rupture. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024; 77:176-178. [PMID: 37734550 DOI: 10.1016/j.rec.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/01/2023] [Indexed: 09/23/2023]
Affiliation(s)
- Álvaro Pinar Abellán
- Servicio de Cardiología, Complejo Hospitalario Universitario de Albacete, Albacete, Spain.
| | - Macarena López Vázquez
- Servicio de Cardiología, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | | | - Arsenio Gallardo López
- Servicio de Cardiología, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Jesús Jiménez Mazuecos
- Servicio de Cardiología, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Driss Melehi El Assali
- Servicio de Cardiología, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
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Srinivasan A, Wong F, Wang B. Transcatheter aortic valve replacement: Past, present, and future. Clin Cardiol 2024; 47:e24209. [PMID: 38269636 PMCID: PMC10788655 DOI: 10.1002/clc.24209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 12/15/2023] [Accepted: 12/20/2023] [Indexed: 01/26/2024] Open
Abstract
Transcatheter aortic valve replacement (TAVR) has emerged as a ground-breaking, minimally invasive alternative to traditional open-heart surgery, primarily designed for elderly patients initially considered unsuitable for surgical intervention due to severe aortic stenosis. As a result of successful large-scale trials, TAVR is now being routinely applied to a broader spectrum of patients. In deciding between TAVR and surgical aortic valve replacement, clinicians evaluate various factors, including patient suitability and anatomy through preprocedural imaging, which guides prosthetic valve sizing and access site selection. Patient surgical risk is a pivotal consideration, with a multidisciplinary team making the ultimate decision in the patient's best interest. Periprocedural imaging aids real-time visualization but is influenced by anaesthesia choices. A comprehensive postprocedural assessment is critical due to potential TAVR-related complications. Numerous trials have demonstrated that TAVR matches or surpasses surgery for patients with diverse surgical risk profiles, ranging from extreme to low risk. However, long-term follow-up data, particularly in low-risk cases, remains limited, and the applicability of published results to younger patients is uncertain. This review delves into key TAVR studies, pinpointing areas for potential improvement while delving into the future of this innovative procedure. Furthermore, it explores the expanding role of TAVR technology in addressing other heart valve replacement procedures.
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Affiliation(s)
- Akash Srinivasan
- Division of Medical Sciences, Nuffield Department of Surgical SciencesUniversity of OxfordOxfordUK
| | - Felyx Wong
- Guy's and St Thomas’ NHS Foundation TrustLondonUK
| | - Brian Wang
- Department of Metabolism, Digestion and Reproduction, Faculty of MedicineImperial College LondonLondonUK
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Stolte T, Boeddinghaus J, Allegra G, Leibundgut G, Reuthebuch O, Kaiser C, Müller C, Nestelberger T. Incidence and Outcomes of Valve-in-Valve Transcatheter Aortic Valve Implantation in Failed Bioprosthetic Valves. J Clin Med 2023; 12:5868. [PMID: 37762811 PMCID: PMC10531770 DOI: 10.3390/jcm12185868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 07/28/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
INTRODUCTION Transcatheter aortic valve replacement (TAVR) has become a widely used, comparably efficient and safe alternative to surgical aortic valve replacement (SAVR). Its utilization continues to grow, especially among younger patients. Despite improvements in durability, degeneration and subsequent re-interventions of failed prosthetic valves are still common. Even though valve-in-valve procedures have become more frequent, little is known about the trends over time or about clinical and echocardiographic long-term outcomes. MATERIALS AND METHODS Patients who underwent a valve-in-valve procedure between December 2011 and December 2022 in a large tertiary university hospital were analyzed. Primary outcomes were defined as procedural and device successes as well as event-free survival. Secondary analyses between subsets of patients divided by index valve and date of procedure were performed. RESULTS Among 1407 procedures, 58 (4%) were valve-in-valve interventions, with an increased frequency observed over time. Overall, technical success was achieved in 88% and device success in 85% of patients. Complications were predominantly minor, with similar success rates among TAVR-in-SAVR (TiSAVR) and TAVR-in-TAVR (TiTAVR). Notably, there were significant and lasting improvements in mean echocardiographic gradients at 1 year. Event-free survival was 76% at one month and 69% at one year. CONCLUSIONS Over the last decade, a rising trend of valve-in-valve procedures was observed. Despite an increase in procedures, complications show a contrasting decline with improved technical and device success over time. TiSAVR and TiTAVR showed comparable rates of procedural and device success as well as similar outcomes, highlighting the utility of valve-in-valve procedures in an aging population.
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Affiliation(s)
- Thorald Stolte
- Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Department of Health Sciences and Technology, Swiss Federal Institute of Technology, 8092 Zurich, Switzerland
| | - Jasper Boeddinghaus
- Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
- British Heart Foundation, University Centre for Cardiovascular Science, Usher Institute, University of Edinburgh, Edinburgh EH16 4SS, UK
| | - Giampiero Allegra
- Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Gregor Leibundgut
- Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Oliver Reuthebuch
- Department of Cardiac Surgery, University Hospital Basel, University of Basel, 4031 Basel, Switzerland
| | - Christoph Kaiser
- Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Christian Müller
- Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Thomas Nestelberger
- Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
- British Heart Foundation, University Centre for Cardiovascular Science, Usher Institute, University of Edinburgh, Edinburgh EH16 4SS, UK
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Porto A, Stolpe G, Badaoui R, Boudouresques V, Deutsch C, Amanatiou C, Riberi A, Gariboldi V, Collart F, Theron A. One-year clinical outcomes following Edwards INSPIRIS RESILIA aortic valve implantation in 487 young patients with severe aortic stenosis: a single-center experience. Front Cardiovasc Med 2023; 10:1196447. [PMID: 37600038 PMCID: PMC10435896 DOI: 10.3389/fcvm.2023.1196447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/26/2023] [Indexed: 08/22/2023] Open
Abstract
Introduction The use of an aortic bioprosthesis is on the rise in younger patients with severe aortic stenosis despite the risk of accelerated structural valve degeneration (SVD). In the search for an optimal valve substitute that would not be prone to SVD, the INSPIRIS bioprosthesis represents a promising solution to lowering the risk of SVD. Here, we report the 1-year outcomes of the INSPIRIS RESILIA aortic bioprosthesis in a population of young patients who underwent aortic valve replacement. Methods In this prospective single-center study, we included all consecutive patients receiving INSPIRIS RESILIA bioprosthesis between June 2017 and July 2021. Patients with isolated severe aortic regurgitation were excluded. Clinical assessment and transthoracic echocardiography were performed preoperatively and at 1 year post-operatively. The primary outcome was overall mortality at one year. Results A total of 487 patients were included. The mean age was 58.2 ± 11.5 years, 75.2% were men. Most of the interventions were elective, with a mean EuroSCORE II of 4.8 ± 7.9. The valve annulus size in most cases was either 23 mm or 25 mm. Overall mortality at 1-year was 4.1%. At 1-year, 7 patients (1.4%) had a stroke, 4 patients (0.8%) had a myocardial infarction, and 20 patients (4.1%) were hospitalized for congestive heart failure. The Kaplan-Meier estimated survival rates and survival without major adverse cardiac events at 1-year were 96.4% and 96.7%, respectively. At 1-year follow-up, 10 patients (2.1%) had endocarditis and 1 patient (0.2%) had partial prosthetic thrombosis. Pacemaker implantation at 1-year post-operative was necessary in 27 patients (5.5%). Severe patient prosthesis mismatch and severe intra valvular regurgitation were 1.2% and 0.6%, respectively. The Kaplan-Meier estimated survival rates at 1-year of no infective endocarditis preoperative and infective endocarditis preoperative were 97.9 ± 0.7% and 89.5 ± 3.3%, respectively (P < 0.001). Excluding endocarditis-related complication, no structural valve deterioration and no valve failure requiring redo surgery were reported. Conclusion This is the largest single-center descriptive study of the 1-year outcomes after INSPIRIS RESILIA bioprosthesis implantation. The EDWARDS INSPIRIS RESILIA bioprosthesis provides encouraging clinical outcomes with an excellent 1- year survival rates and good hemodynamic performance. Long-term studies are mandatory to assess valve durability.
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Affiliation(s)
- Alizee Porto
- Department of Cardiac Surgery, APHM, Timone Hospital, Marseille, France
| | - Gregoire Stolpe
- Department of Cardiac Surgery, APHM, Timone Hospital, Marseille, France
| | - Rita Badaoui
- Department of Cardiac Surgery, APHM, Timone Hospital, Marseille, France
| | | | - Cornelia Deutsch
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Cecile Amanatiou
- Department of Cardiac Surgery, APHM, Timone Hospital, Marseille, France
| | - Alberto Riberi
- Department of Cardiac Surgery, APHM, Timone Hospital, Marseille, France
| | - Vlad Gariboldi
- Department of Cardiac Surgery, APHM, Timone Hospital, Marseille, France
| | - Frédéric Collart
- Department of Cardiac Surgery, APHM, Timone Hospital, Marseille, France
| | - Alexis Theron
- Department of Cardiac Surgery, APHM, Timone Hospital, Marseille, France
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Zubarevich A, Beltsios ET, Arjomandi Rad A, Amanov L, Szczechowicz M, Ruhparwar A, Weymann A. Sutureless Aortic Valve Prosthesis in Redo Procedures: Single-Center Experience. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1126. [PMID: 37374330 DOI: 10.3390/medicina59061126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 06/07/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023]
Abstract
Background and Objectives: Sutureless aortic valve prostheses have presented favorable hemodynamic performance while facilitating minimally invasive access approaches. As the population ages, the number of patients at risk for aortic valve reoperation constantly increases. The aim of the present study is to present our single-center experience in sutureless aortic valve replacement (SU-AVR) in reoperations. Materials and Methods: The data of 18 consecutive patients who underwent SU-AVR in a reoperation between May 2020 and January 2023 were retrospectively analyzed. Results: The mean age of the patients was 67.9 ± 11.1 years; patients showed a moderate-risk profile with a median logistic EuroSCORE II of 7.8 (IQR of 3.8-32.0) %. The implantation of the Perceval S prosthesis was technically successful in all patients. The mean cardiopulmonary bypass time was 103.3 ± 50.0 min, and the cross-clamp time was 69.1 ± 38.8 min. No patients required a permanent pacemaker implantation. The postoperative gradient was 7.3 ± 2.4 mmHg, and no cases of paravalvular leakage were observed. There was one case of intraprocedural death, while the thirty-day mortality was 11%. Conclusions: Sutureless bioprosthetic valves tend to simplify the surgical procedure of a redo AVR. By maximizing the effective orifice area, sutureless valves may present an important advantage, being a safe and effective alternative not only to traditional surgical prostheses but also to transcatheter valve-in-valve approaches in select cases.
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Affiliation(s)
- Alina Zubarevich
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Hufelandstraße 55, 45122 Essen, Germany
| | - Eleftherios T Beltsios
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Hufelandstraße 55, 45122 Essen, Germany
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany
| | | | - Lukman Amanov
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Hufelandstraße 55, 45122 Essen, Germany
| | - Marcin Szczechowicz
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Hufelandstraße 55, 45122 Essen, Germany
| | - Arjang Ruhparwar
- Medical Sciences Division, University of Oxford, Oxford OX3 9DU, UK
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Klotzka A, Woźniak P, Misterski M, Rodzki M, Puślecki M, Jemielity M, Grygier M, Araszkiewicz A, Iwańczyk S, Buczkowski P. Open-Heart Cardio-Thoracic Biological Valve Replacement Following Complicated Transcatheter Aortic Valve Implantation. J Pers Med 2023; 13:jpm13050838. [PMID: 37241008 DOI: 10.3390/jpm13050838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/11/2023] [Accepted: 05/13/2023] [Indexed: 05/28/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) is currently becoming the method of choice in high-risk patients with severe aortic valve stenosis. Post-TAVI complications are more common owing to the increasing use of the method. The majority of TAVI complications derive from concomitant aortic stenosis with moderate/severe aortic insufficiency, paravalvular leak, and atrioventricular block. The contemporary TAVI qualification process includes a thorough echocardiography and angio-CT of the aorta, which is crucial in assessing valve measurements, determining the position of the coronary arteries branching from the aorta, and choosing the optimal valve size. We present the case report of an 81-year-old patient admitted to our hospital because of exacerbation of the clinical condition and development of pulmonary edema a few days after TAVI. Despite the reduction of the initial leak, an echocardiographic examination revealed the remaining severe paravalvular aortic leakage. We performed open-heart cardio-thoracic surgery, explanted the TAVI valve, and implanted the biological prosthesis (Edwards Perimount Magna size 25). Introduction of new interventional treatment approaches and the availability of imaging tools have substantially reduced the incidence of significant paravalvular leak and offered a better prognosis for patients undergoing TAVI.
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Affiliation(s)
- Aneta Klotzka
- Department of Cardiology, Poznan University of Medical Sciences, Długa 1/2 Street, 61-848 Poznan, Poland
| | - Patrycja Woźniak
- Department of Cardiology, Poznan University of Medical Sciences, Długa 1/2 Street, 61-848 Poznan, Poland
| | - Marcin Misterski
- Cardiac Surgery and Transplanthology Department, Poznan University of Medical Sciences, Długa ½ Street, 61-848 Poznan, Poland
| | - Michał Rodzki
- Cardiac Surgery and Transplanthology Department, Poznan University of Medical Sciences, Długa ½ Street, 61-848 Poznan, Poland
| | - Mateusz Puślecki
- Cardiac Surgery and Transplanthology Department, Poznan University of Medical Sciences, Długa ½ Street, 61-848 Poznan, Poland
| | - Marek Jemielity
- Cardiac Surgery and Transplanthology Department, Poznan University of Medical Sciences, Długa ½ Street, 61-848 Poznan, Poland
| | - Marek Grygier
- Department of Cardiology, Poznan University of Medical Sciences, Długa 1/2 Street, 61-848 Poznan, Poland
| | - Aleksander Araszkiewicz
- Department of Cardiology, Poznan University of Medical Sciences, Długa 1/2 Street, 61-848 Poznan, Poland
| | - Sylwia Iwańczyk
- Department of Cardiology, Poznan University of Medical Sciences, Długa 1/2 Street, 61-848 Poznan, Poland
| | - Piotr Buczkowski
- Cardiac Surgery and Transplanthology Department, Poznan University of Medical Sciences, Długa ½ Street, 61-848 Poznan, Poland
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10
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Ullah W, DiMeglio M, Sana MK, Muhammadzai HZU, Kochar K, Zahid S, Kumar A, Michos ED, Mamas MA, Fischman DL, Savage MP, Bhatt DL, Shah P. Outcomes After Transcatheter Aortic Valve Implantation in Patients Excluded From Clinical Trials. JACC. ADVANCES 2023; 2:100271. [PMID: 38938299 PMCID: PMC11198040 DOI: 10.1016/j.jacadv.2023.100271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/29/2022] [Accepted: 01/17/2023] [Indexed: 06/29/2024]
Abstract
Background The use of transcatheter aortic valve implantation (TAVI) in patients with aortic valve disease excluded from clinical trials has increased with no large-scale data on its safety. Objectives The purpose of this study was to assess the trend of utilization and adjusted outcomes of TAVI in clinical trials excluded (CTE) vs clinical trials included TAVI (CTI-TAVI) patients. Methods We used the National Readmission Database (2015-2019) to identify 15 CTE-TAVI conditions. A propensity score-matched analysis was used to calculate the adjusted odds ratio (aOR) of net adverse clinical events (composite of mortality, stroke, and major bleeding) in patients undergoing CTE-TAVI vs CTI-TAVI. Results Among the 223,238 patients undergoing TAVI, CTE-TAVI was used in 41,408 patients (18.5%). The yearly trend showed a steep increase in CTE-TAVI utilization (P = 0.026). At index admission, the adjusted odds of net adverse clinical events (aOR: 1.83, 95% CI: 1.73-1.95) and its components, including mortality (aOR: 2.94, 95% CI: 2.66-3.24), stroke (aOR: 1.20, 95% CI: 1.07-1.34), and major bleeding (aOR: 1.49, 95% CI: 1.36-1.63) were significantly higher in CTE-TAVI compared with CTI-TAVI. Among the individual contraindications to clinical trial enrollment in the CTE-TAVI, patients with bicuspid aortic valve, leukopenia, and peptic ulcer disease appeared to have similar outcomes compared with CTI-TAVI, while patients with end-stage renal disease, bioprosthetic aortic valves, and coagulopathy had a higher readmission rate at 30 and 180 days. Conclusions CTE-TAVI utilization has increased significantly over the 4-year study period. Patients undergoing CTE-TAVI have a higher likelihood of mortality, stroke, and bleeding than those undergoing CTI-TAVI.
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Affiliation(s)
- Waqas Ullah
- Department of Cardiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Matthew DiMeglio
- Department of Cardiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Muhammad Khawar Sana
- Department of Cardiology, John H Stroger Jr Hospital of Cook County, Chicago, Illinois, USA
| | | | - Kirpal Kochar
- Department of Cardiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Salman Zahid
- Department of Cardiology, Rochester Regional Health, Rochester, New York, USA
| | - Arnav Kumar
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Erin D. Michos
- Department of Cardiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Mamas A. Mamas
- Department of Cardiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
- Department of Cardiology, Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Stoke-on-Trent, United Kingdom
| | - David L. Fischman
- Department of Cardiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Michael P. Savage
- Department of Cardiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Deepak L. Bhatt
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai Health System, New York, New York, USA
| | - Pinak Shah
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts, USA
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11
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Tully A, Tom S, Xie J, O'Brian C, Gleason P, Grubb KJ. Evolving computed tomography angiography for aortic valve replacement: Optimizing transcatheter and surgical therapies. J Card Surg 2022; 37:4124-4132. [PMID: 36168827 DOI: 10.1111/jocs.16977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 09/13/2022] [Indexed: 01/06/2023]
Abstract
Transcatheter aortic valve replacement (TAVR) has transformed the treatment of aortic stenosis and pre-procedure planning relies heavily on advanced imaging. Multidetector computed tomography angiography, the "TAVR CT," facilitates essential planning steps of measuring the aortic root for valve sizing and feasibility and assessment of potential access vessels, making it the guideline gold standard in preprocedural TAVR work up. This Impact of Advanced Imaging Techniques on Cardiac Surgery article will examine the development of TAVR CT, illustrate the current impact and utility, and highlight potential areas of future growth. Clinicians who keep informed of these changes and can become proficient with TAVR CT analyses will offer patients the most optimal results and fuel future therapeutic growth.
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Affiliation(s)
- Andrew Tully
- Division of Cardiothoracic Surgery, Emory University, Atlanta, Georgia, USA.,Structural Heart and Valve Center, Emory University, Atlanta, Georgia, USA
| | - Stephanie Tom
- Structural Heart and Valve Center, Emory University, Atlanta, Georgia, USA.,Department of Surgery, Emory University, Atlanta, Georgia, USA
| | - Joe Xie
- Structural Heart and Valve Center, Emory University, Atlanta, Georgia, USA.,Division of Cardiology, Emory University, Atlanta, Georgia, USA
| | - Colin O'Brian
- Structural Heart and Valve Center, Emory University, Atlanta, Georgia, USA.,Division of Cardiology, Emory University, Atlanta, Georgia, USA
| | - Patrick Gleason
- Structural Heart and Valve Center, Emory University, Atlanta, Georgia, USA.,Division of Cardiology, Emory University, Atlanta, Georgia, USA
| | - Kendra J Grubb
- Division of Cardiothoracic Surgery, Emory University, Atlanta, Georgia, USA.,Structural Heart and Valve Center, Emory University, Atlanta, Georgia, USA
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12
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Assmann A, Schmidt V, Lepke C, Sugimura Y, Assmann AK, Barth M, Lichtenberg A, Akhyari P. Degeneration of biological heart valve grafts in a rat model of superoxide dismutase-3 deficiency. FASEB J 2022; 36:e22591. [PMID: 36251410 DOI: 10.1096/fj.202200727rr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 09/21/2022] [Accepted: 09/26/2022] [Indexed: 11/11/2022]
Abstract
While oxidative stress is known as key element in the pathogenesis of atherosclerosis and calcific aortic valve disease, its role in the degeneration of biological cardiovascular grafts has not been clarified yet. Therefore, the present study aimed to examine the impact of oxidative stress on the degeneration of biological cardiovascular allografts in a standardized chronic implantation model realized in rats exhibiting superoxide dismutase 3 deficiency (SOD3(-) ). Rats with SOD3 loss-of-function mutation (n = 24) underwent infrarenal implantation of cryopreserved valved aortic conduits, while SOD3-competent recipients served as controls (n = 28). After a follow-up period of 4 or 12 weeks, comparative analyses addressed degenerative processes, hemodynamics, and evaluation of the oxidative stress model. SOD3(-) rats presented decreased circulating SOD activity (p = .0079). After 12 weeks, 58% of the implant valves in SOD3(-) rats showed regurgitation (vs. 31% in controls, p = .2377). Intima hyperplasia and chondro-osteogenic transformation contributed to progressive graft calcification (p = .0024). At 12 weeks, hydroxyapatite deposition (p = .0198) and the gene expression of runt-related transcription factor-2 (Runx2) (p = .0093) were significantly enhanced in group SOD3(-) . This study provides the first in vivo evidence that impaired systemic antioxidant activity contributes to biological cardiovascular graft degeneration.
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Affiliation(s)
- Alexander Assmann
- Department of Cardiac Surgery and Research Group for Experimental Surgery, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
| | - Vera Schmidt
- Department of Cardiac Surgery and Research Group for Experimental Surgery, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
| | - Caroline Lepke
- Department of Cardiac Surgery and Research Group for Experimental Surgery, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
| | - Yukiharu Sugimura
- Department of Cardiac Surgery and Research Group for Experimental Surgery, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
| | - Anna Kathrin Assmann
- Department of Cardiac Surgery and Research Group for Experimental Surgery, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
| | - Mareike Barth
- Department of Cardiac Surgery and Research Group for Experimental Surgery, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
| | - Artur Lichtenberg
- Department of Cardiac Surgery and Research Group for Experimental Surgery, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany.,CARID-Cardiovascular Research Institute Düsseldorf, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
| | - Payam Akhyari
- Department of Cardiac Surgery and Research Group for Experimental Surgery, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
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13
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Bhushan S, Huang X, Li Y, He S, Mao L, Hong W, Xiao Z. Paravalvular Leak After Transcatheter Aortic Valve Implantation Its Incidence, Diagnosis, Clinical Implications, Prevention, Management, and Future Perspectives: A Review Article. Curr Probl Cardiol 2022; 47:100957. [DOI: https:/doi.org/10.1016/j.cpcardiol.2021.100957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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14
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Seckin ZI, Umadat G, White RO. 71-Year-Old Man With a New Heart Murmur. Mayo Clin Proc 2022; 97:1717-1722. [PMID: 36058583 DOI: 10.1016/j.mayocp.2022.02.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 02/22/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Zeynep I Seckin
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Jacksonville, FL
| | - Goyal Umadat
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Jacksonville, FL
| | - Richard O White
- Advisor to residents and Consultant in Community Internal Medicine, Mayo Clinic, Jacksonville, FL.
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15
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Gill J, Zahra F, Retzer E. In-Hospital Outcomes and Predictors of Mortality for Redo Surgical Mitral Valve Replacement Versus Transcatheter Mitral Valve-in-Valve Replacement. Am J Cardiol 2022; 176:89-95. [PMID: 35644696 DOI: 10.1016/j.amjcard.2022.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/09/2022] [Accepted: 04/14/2022] [Indexed: 11/01/2022]
Abstract
Durability is a major limitation with bioprosthetic heart valves. For mitral valve prosthesis dysfunction, redo surgical mitral valve replacement (rSMVR) has been the mainstay of treatment; however, transcatheter mitral valve-in-valve replacement (mViV) has emerged as a viable alternative. Data comparing these procedures remains limited; therefore, we sought to compare the real-world in-hospital mortality, likelihood of adverse peri-operative outcomes, and predictors of mortality between rSMVR versus mViV using the National Inpatient Sample. During the study period, a weighted total of 1,890 patients (78%) underwent rSMVR, and 520 (22%) underwent mViV. After propensity matching, there were 310 patients in each cohort. There was no statistically significant difference in mortality with these procedures (odds ratio 1.53; 95% confidence interval 0.67 to 3.45; p = 0.31). rSMVR was associated with increased length of hospitalization (13 vs 7.5 days; p <0.001), increased medical costs ($324,124 vs $241,147; p <0.001), and increased peri-operative complications compared with mViV. Predictors of mortality unique to rSMVR were age >75 years, cirrhosis, sleep apnea, malnourishment/low body mass index, and obesity, signalizing greater suitability for mViV in these populations.
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16
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Balloon Fracturing Valve-in-Valve: How to Do It and a Case Report of TAVR in a Rapid Deployment Prosthesis. J Interv Cardiol 2022; 2022:4368887. [PMID: 35600211 PMCID: PMC9095411 DOI: 10.1155/2022/4368887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 04/05/2022] [Indexed: 11/17/2022] Open
Abstract
Transcatheter aortic valve replacement (TAVR) to treat degeneration of bioprosthetic heart valves (BHVs), called as valve-in-valve (ViV), is becoming a key feature since the number of BHVs requiring intervention is increasing and many patients are at high risk for a redo cardiac surgery. However, a TAVR inside a small previous cardiac valve may lead to prosthesis-patient mismatch (PPM) and not be as effective as we hoped for. An effective option to decrease the chance of PPM is to fracture the previous heart valve implanted using a high-pressure balloon. By performing a valve fracture, the inner valve ring of small BHVs can be opened up by a single fracture line, allowing subsequent implantation of a properly sized transcatheter heart valve, without increasing substantially the procedure risk. In this article, we provide a step-by-step procedure on how to safely and properly fracture a BHV and report a case of a TAVR in a degenerated rapid deployment valve.
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17
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Artificial Intelligence-Based Spiral CT 3D Reconstruction in Transcatheter Aortic Valve Implantation. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:5794681. [PMID: 35572825 PMCID: PMC9095377 DOI: 10.1155/2022/5794681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 04/07/2022] [Accepted: 04/09/2022] [Indexed: 11/18/2022]
Abstract
To evaluate the clinical application effect of spiral computed tomography (CT) three-dimensional (3D) reconstruction based on artificial intelligence in transcatheter aortic valve implantation (TAVI), a CT 3D reconstruction model based on deep convolutional neural networks (DCNN) was established in this research, which was compared with the model-based iterative reconstruction (MBIR) and used in clinical practice. Then, 62 patients with aortic stenosis (AS) who underwent TAVI surgery were recruited as the research objects. The accuracy, sensitivity, and specificity of the multislice spiral CT scan (MSCT) and transthoracic echocardiography (TTE) in predicting the type of TAVI surgical valve were compared and analyzed. The results showed that the mean absolute error (MAE) (0.01) and root mean square error (RMSE) (0.086) of the MBIR model were higher than the reconstruction model in this research. The structural similarity (SSIM) (0.831) and peak signal-to noise ratio (PSNR) (32.77 dB) of the MBIR model were lower than the reconstruction model, and the differences were considerable (
). Of the valve models selected based on the TTE measurement results, 35 cases were accurately predicted and 27 cases were incorrectly predicted. The accuracy of MSCT was 87.1%, the specificity was 98.84%, and the sensitivity was 92.87%; all of which were significantly higher than TTE (
). In summary, compared with the MBIR reconstruction model, the imaging results of the model established in this research were closer to the real image. Compared with TTE, MSCT had higher accuracy, sensitivity, and specificity and can provide more accurate preoperative predictions for patients undergoing TAVI surgery.
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18
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Tasoudis PT, Varvoglis DN, Vitkos E, Mylonas KS, Sá MP, Ikonomidis JS, Caranasos TG, Athanasiou T. Mechanical versus Bioprosthetic Valve for Aortic Valve Replacement: Systematic Review and Meta-Analysis of Reconstructed Individual Participant Data. Eur J Cardiothorac Surg 2022; 62:6571808. [PMID: 35445694 DOI: 10.1093/ejcts/ezac268] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 04/14/2022] [Accepted: 04/18/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To compare biological versus mechanical aortic valve replacement. METHODS We searched MEDLINE, Scopus, and Cochrane Library databases for randomized clinical trials and propensity-score matched studies published by October 14th, 2021 according to PRISMA statement. Individual patient data on overall survival were extracted. One- and two-stage survival analyses, and random-effects meta-analyses were conducted. RESULTS 25 studies were identified, incorporating 8,721 bioprosthetic and 8,962 mechanical valves:. In the one-stage meta-analysis, mechanical valves cumulatively demonstrated decreased hazard for mortality (Hazard Ratio [HR] : 0.79, 95% Confidence interval [CI] : 0.74-0.84, p < 0.0001). Overall survival was similar between the compared arms for patients <50 years old (HR: 0.88, 95% CI : 0.71-1.1, p = 0.216), increased in the mechanical valve arm for patients 50-70 years old (HR : 0.76, 95% CI : 0.70-0.83, p < 0.0001), and increased in the bioprosthetic arm for patients >70 years old (HR : 1.35, 95% CI : 1.17-1.57, p < 0.0001). Meta-regression analysis revealed that the survival in the 50-70 years old group was not influenced by the publication year of the individual studies. No statistically significant difference was observed regarding in-hospital mortality, post-operative strokes and post-operative reoperation. All-cause mortality was found decreased in the mechanical group, cardiac mortality was comparable between the two groups, major bleeding rates were increased in the mechanical valve group, and reoperation rates were increased in the bioprosthetic valve group. CONCLUSIONS Survival rates seem to not be influenced by the type of prosthesis in patients <50 years old. A survival advantage in favour of mechanical valves is observed in patients 50-70 years old, while in patients >70 years old bioprosthetic valves offer better survival outcomes.
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Affiliation(s)
- Panagiotis T Tasoudis
- Department of Cardiothoracic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, Larissa, Greece; Surgery Working Group, Society of Junior Doctors, Athens, Greece
| | - Dimitrios N Varvoglis
- Department of Cardiothoracic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, Larissa, Greece; Surgery Working Group, Society of Junior Doctors, Athens, Greece
| | - Evangelos Vitkos
- Department of Cardiothoracic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, Larissa, Greece; Surgery Working Group, Society of Junior Doctors, Athens, Greece
| | | | - Michel Pompeu Sá
- Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA
| | - John S Ikonomidis
- Professor of Surgery, Chief, Division of Cardiothoracic Surgery, Department of Surgery, School of Medicine, University of North Carolina, at Chapel Hill Chapel Hill, NC
| | - Thomas G Caranasos
- Division of Cardiothoracic Surgery, Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Thanos Athanasiou
- Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, W2 1NY, UK, Department of Cardiothoracic Surgery, University Hospital of Larissa, Biopolis, Larissa, Greece, 41110
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19
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Magnetic retrieval of prosthetic heart valves for redo-TAVI. Med Eng Phys 2022; 101:103761. [DOI: 10.1016/j.medengphy.2022.103761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 12/14/2021] [Accepted: 01/18/2022] [Indexed: 12/22/2022]
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20
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Lodo V, De Benedictis M, Scrocca I, Zingarelli EM, Fadde M, Buono G, Musumeci G, Centofanti P. Matryoshka
procedure for Valve‐in‐Valve TAVI failure. Clin Case Rep 2022; 10:e05422. [PMID: 35145696 PMCID: PMC8818287 DOI: 10.1002/ccr3.5422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 12/02/2021] [Accepted: 01/25/2022] [Indexed: 11/17/2022] Open
Abstract
Valve‐in‐valve transcatheter valve implantation (ViV‐TAVI) procedures for deteriorated bioprosthesis are an established therapeutic option for high‐risk patients. The presence of the fixed sewing ring of the bioprosthesis can hamper appropriate expansion of the TAVI. We present a case of a ViViV‐TAVI, as a salvage procedure for acute ViV‐TAVI failure.
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Affiliation(s)
- Vittoria Lodo
- Division of Cardiac Surgery Azienda Ospedaliera Ordine Mauriziano di Torino Turin Italy
| | - Mauro De Benedictis
- Division of Cardiology Azienda Ospedaliera Ordine Mauriziano di Torino Turin Italy
| | - Innocenzo Scrocca
- Division of Cardiology Azienda Ospedaliera Ordine Mauriziano di Torino Turin Italy
| | - Edoardo M. Zingarelli
- Division of Cardiac Surgery Azienda Ospedaliera Ordine Mauriziano di Torino Turin Italy
| | - Marco Fadde
- Division of Cardiovascular Anesthesia and Intensive Care Azienda Ospedaliera Ordine Mauriziano Turin Italy
| | - Gabriella Buono
- Division of Cardiovascular Anesthesia and Intensive Care Azienda Ospedaliera Ordine Mauriziano Turin Italy
| | - Giuseppe Musumeci
- Division of Cardiology Azienda Ospedaliera Ordine Mauriziano di Torino Turin Italy
| | - Paolo Centofanti
- Division of Cardiac Surgery Azienda Ospedaliera Ordine Mauriziano di Torino Turin Italy
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21
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Joury A, Duran A, Stewart M, Gilliland YE, Spindel SM, Qamruddin S. Prosthesis-patient mismatch following aortic and mitral valves replacement – A comprehensive review. Prog Cardiovasc Dis 2022; 72:84-92. [PMID: 35235847 DOI: 10.1016/j.pcad.2022.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 02/22/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Abdulaziz Joury
- Department of Cardiology, Ochsner Medical Center, New Orleans, LA, United States of America; King Salman Heart Center, King Fahad Medical City, Riyadh, Saudi Arabia.
| | - Antonio Duran
- Department of Cardiology, Ochsner Medical Center, New Orleans, LA, United States of America; Ochsner Clinical School, New Orleans, LA, United States of America.
| | - Merrill Stewart
- Department of Cardiology, Ochsner Medical Center, New Orleans, LA, United States of America; Ochsner Clinical School, New Orleans, LA, United States of America.
| | - Yvonne E Gilliland
- Department of Cardiology, Ochsner Medical Center, New Orleans, LA, United States of America; Ochsner Clinical School, New Orleans, LA, United States of America
| | - Stephen M Spindel
- Ochsner Clinical School, New Orleans, LA, United States of America; Division of Cardiothoracic Surgery, Ochsner Medical Center, New Orleans, LA, United States of America.
| | - Salima Qamruddin
- Department of Cardiology, Ochsner Medical Center, New Orleans, LA, United States of America; Ochsner Clinical School, New Orleans, LA, United States of America.
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22
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Pontone G, Marano R, Agricola E, Alushi B, Bartorelli A, Cameli M, Carrabba N, Esposito A, Faletti R, Francone M, Galea N, Golino P, Guglielmo M, Palmisano A, Petronio S, Petullà M, Pradella S, Ribichini F, Romeo F, Russo V, Scandura S, Schicchi N, Spaccarotella C, Tomai F, Centonze M, indolfi C. Recommendations in pre-procedural imaging assessment for transcatheter aortic valve implantation intervention. J Cardiovasc Med (Hagerstown) 2022; 23:216-227. [DOI: 10.2459/jcm.0000000000001293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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23
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Randall M, Betageri O, Hanayneh S, Anderson RD. Paravalvular Leak: A Systemic Review. Curr Cardiol Rev 2022; 18:e110522204571. [PMID: 35546743 PMCID: PMC9893144 DOI: 10.2174/1573403x18666220511113310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 03/10/2022] [Accepted: 03/15/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Paravalvular Leak (PVL) refers to the retrograde flow of blood in the space between an implanted cardiac valve and native tissue. These are unfortunately but luckily relatively uncommon complications of prosthetic valve replacement that, especially when moderate or severe, have important clinical consequences. OBJECTIVE Addressing PVL requires a multidisciplinary team to properly diagnose this process and choose the corrective option most likely to result in success. METHODS A comprehensive literature search was undertaken to formulate this narrative review. RESULTS This review highlights the complex nature of PVL and the promising contemporary treatments available. CONCLUSION Clinicians should be adept at recognizing PVL and characterizing it using multimodality imaging. Using the many available tools and a multidisciplinary approach should lead to favorable outcomes in patients with PVL.
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Affiliation(s)
- Morgan Randall
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, FL 32611, USA
| | - Omkar Betageri
- Department of Medicine, University of Florida, Gainesville, FL 32611, USA
| | - Seri Hanayneh
- Department of Medicine, University of Florida, Gainesville, FL 32611, USA
| | - R. David Anderson
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, FL 32611, USA
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24
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Salgado R, El Addouli H, Budde RPJ. Transcatheter Aortic Valve Implantation: The Evolving Role of the Radiologist in 2021. ROFO-FORTSCHR RONTG 2021; 193:1411-1425. [PMID: 34814198 DOI: 10.1055/a-1645-1873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) has gained worldwide acceptance and implementation as an alternative therapeutic option in patients with severe aortic valve stenosis unable to safely undergo surgical aortic valve replacement. This transformative technique places the radiologist in a key position in the pre-procedural assessment of potential candidates for this technique, delivering key anatomical information necessary for patient eligibility and procedural safety. Recent trials also provide encouraging results to potentially extend the indication to patients with safer risk profiles. METHOD The review is based on a PubMed literature search using the search terms "transcatheter heart valve", "TAVI", "TAVR", "CT", "imaging", "MR" over a period from 2010-2020, combined with personal comments based on the author's experience. RESULTS AND CONCLUSION CT plays a prominent role in the pre-procedural workup, delivering as a true 3D imaging modality optimal visualization of the complex anatomy of the aortic root with simultaneous evaluation of the patency of the different access routes. As such, the contribution of CT is key for the determination of patient eligibility and procedural safety. This input is supplementary to the contributions of other imaging modalities and forms an important element in the discussions of the Heart Valve Team. Knowledge of the procedure and its characteristics is necessary in order to provide a comprehensive and complete report. While the role of CT in the pre-procedural evaluation is well established, the contribution of CT and MR and the clinical significance of their findings in the routine follow-up after the intervention are less clear and currently the subject of intense investigation. Important issues remain, including the occurrence and significance of subclinical leaflet thrombosis, prosthetic heart valve endocarditis, and long-term structural valve degeneration. KEY POINTS · CT plays a crucial role in evaluating transcatheter heart valve candidates. · Evaluation must include the dimensions of the aortic root and access paths. · The exact post-procedural role of CT and MRI has not yet been determined.. CITATION FORMAT · Salgado R, El Addouli H, Budde RP. Transcatheter Aortic Valve Implantation: The Evolving Role of the Radiologist in 2021. Fortschr Röntgenstr 2021; 193: 1411 - 1425.
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Affiliation(s)
- Rodrigo Salgado
- Radiology, UZA, Edegem, Belgium.,Radiology, Holy Heart Hospital Lier, Belgium
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OS-LALM-OGM Algorithm-Based Computed Tomography Image for Characteristics and Comorbidities of Patients before Transcatheter Aortic Valve Implantation. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:3631208. [PMID: 34804448 PMCID: PMC8601807 DOI: 10.1155/2021/3631208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 09/26/2021] [Accepted: 09/27/2021] [Indexed: 11/24/2022]
Abstract
Based on the ordered subsets (OS), a linear augmentation Lagrangian method (OS-LALM) was constructed, which was then combined with the optimized gradient method (OGM) to construct the OS-LALM-OGM, so as to discuss application of the computed tomography (CT) images based on OS-LALM-OGM in evaluation of clinical manifestations and complications of patients before transcatheter aortic valve implantation (TAVI). The OS-LALM-OGM was compared with the filtered back projection (FBP) and OS-LALM. In addition, it was applied to evaluate the conditions of 128 patients before TAVI. It was found that the peak signal-to-noise ratio (PSNR) of OS-LALM-OGM was greater than that of the FBP and OS-LALM when the number of iterations was 5, 20, and 40, while the root mean square error (RMSD) was the opposite (P < 0.05). The proportion of dyspnea was the highest, 38.28%, followed by angina (19.53%) and fainting (21.09%). The long diameter of the annulus and the average inner diameter of the annulus measured by the CT image based on the OS-LALM-OGM algorithm were greatly larger than the inner diameter of the aortic annulus measured by the CT based on the FBP algorithm (P < 0.05); the evaluation sensitivity (95.24%) and specificity (85.85%) of CT based on the OS-LALM-OGM algorithm were obviously greater than those of X-ray, which were 84.43% and 76.77%, respectively (P < 0.05). In short, the OS-LALM-OGM proposed had a relatively excellent effect on CT image reconstruction. The CT image based on the OS-LALM-OGM algorithm showed a better evaluation performance for patients before TAVI than the traditional FBP algorithm, showing higher sensitivity and specificity.
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Choosing Between Transcatheter Aortic Valve Replacement and Surgery in the Low-Risk Transcatheter Aortic Valve Replacement Era. Interv Cardiol Clin 2021; 10:413-422. [PMID: 34593105 DOI: 10.1016/j.iccl.2021.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The landmark results of the low surgical risk pivotal transcatheter aortic valve replacement (TAVR) trials fueled speculation that the role of surgical aortic valve replacement (SAVR) would be limited in the future. Instead, the field has pivoted away from reductive surgical risk stratification toward understanding the complex interplay of anatomy, timing, and surgical risk to optimize the lifetime management of aortic stenosis. In this review, we systematically explore the subtleties that influence the choice between TAVR and surgery in the low-risk TAVR era.
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Tamura Y, Tamura Y, Konami Y, Suzuyama H, Horio E, Yamada M, Sassa T, Taguchi E, Horibata Y, Ideta I, Kawamura A, Sakamoto T. Comparison of left ventricular pacing performance among pre-shaped guidewires designed for transfemoral-approach transcatheter aortic valve implantation. Heart Vessels 2021; 37:460-466. [PMID: 34524498 DOI: 10.1007/s00380-021-01938-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/03/2021] [Indexed: 11/30/2022]
Abstract
TAVI is an established therapy for patients with severe aortic stenosis. Rapid or control pacing is necessary for TAVI, and most centers are familiar with right ventricular (RV) pacing. Although there are several reports on the efficacy and safety of LV pacing, they are still few. In addition, LV pacing has not been studied for different LV guidewires. Our aim is to study the effectiveness of left ventricular (LV) pacing and the thresholds of LV guidewires in patients who underwent transcatheter aortic valve implantation (TAVI). We retrospectively analyzed 252 consecutive patients who underwent trans-femoral TAVI (TF-TAVI) with LV pacing in our institute between December 2017 and November 2020. We excluded 48 patients from the total cohort due to TAVI with RV pacing, and the remaining 204 patients were analyzed (52 males, mean age 85 ± 5 years). Among them, 202 patients (99.0%) had successful LV pacing. In the two patients with failed LV pacing, SAFARI2™ Small was used. The CONFIDA™ group (n = 34) showed a significantly lower threshold than the SAFARI2™ group (n = 163) (median 3.0 vs. 5.0 V; P = 1.1 × 10-7). LV pacing with Lunderquist® was successful in all patients (n = 7). LV pacing in TAVI was an effective and safe strategy. CONFIDA™ wire may be particularly well suited for LV pacing in TAVI.
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Affiliation(s)
- Yudai Tamura
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, 5-3-1 Chikami Minami-ku, Kumamoto, 861-4193, Japan.,Department of Cardiology, International University of Health and Welfare School of Medicine, Narita, Japan
| | - Yuichi Tamura
- Department of Cardiology, International University of Health and Welfare School of Medicine, Narita, Japan
| | - Yutaka Konami
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, 5-3-1 Chikami Minami-ku, Kumamoto, 861-4193, Japan
| | - Hiroto Suzuyama
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, 5-3-1 Chikami Minami-ku, Kumamoto, 861-4193, Japan
| | - Eiji Horio
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, 5-3-1 Chikami Minami-ku, Kumamoto, 861-4193, Japan
| | - Masahiro Yamada
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, 5-3-1 Chikami Minami-ku, Kumamoto, 861-4193, Japan
| | - Toshiharu Sassa
- Division of Cardiovascular Surgery, Saiseikai Kumamoto Hospital Cardiovascular Center, 5-3-1 Chikami Minami-ku, Kumamoto, 861-4193, Japan
| | - Eiji Taguchi
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, 5-3-1 Chikami Minami-ku, Kumamoto, 861-4193, Japan
| | - Yoko Horibata
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, 5-3-1 Chikami Minami-ku, Kumamoto, 861-4193, Japan
| | - Ichiro Ideta
- Division of Cardiovascular Surgery, Saiseikai Kumamoto Hospital Cardiovascular Center, 5-3-1 Chikami Minami-ku, Kumamoto, 861-4193, Japan
| | - Akio Kawamura
- Department of Cardiology, International University of Health and Welfare School of Medicine, Narita, Japan
| | - Tomohiro Sakamoto
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, 5-3-1 Chikami Minami-ku, Kumamoto, 861-4193, Japan.
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Yokoyama Y, Kuno T, Takagi H, Fukuhara S. Trifecta versus perimount bioprosthesis for surgical aortic valve replacement; systematic review and meta-analysis. J Card Surg 2021; 36:4335-4342. [PMID: 34499386 DOI: 10.1111/jocs.15972] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/30/2021] [Accepted: 08/21/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Recent studies suggested higher rates of early structural valve degeneration or reintervention for the Trifecta valve compared to other valves. Thus, we conducted a systematic review and meta-analysis comparing the outcomes of the Trifecta valve and the Perimount valves in patients who underwent a surgical aortic valve replacement (SAVR). METHODS All randomized control trials and observational studies which investigated the outcomes of the Trifecta valve and Perimount valves were identified with PubMed and EMBASE. The endpoints were the rates of reintervention and all-cause mortality. Hazard ratios (HRs) for reintervention and all-cause mortality were combined with the random-effects model. RESULTS Our search identified 6 eligible observational studies which enrolled a total of 11,135 patients who underwent SAVR with either the Trifecta valve (n = 4932) or Perimount (n = 6203). Pooled analyses demonstrated that the reintervention rates were significantly higher with the Trifecta valve compared with Perimount valves (HR [95% confidence interval {CI}] = 3.16 [1.83-5.46]; p < .0001; I2 = 40%). In contrast, all-cause mortality was not significantly different between the two groups (HR [95% CI] = 1.09 [0.75-1.58]; p = .32, I2 = 12%). CONCLUSION Our analysis showed that AVR with the Trifecta valve was associated with higher rates of reintervention compared for that with the Perimount valve. Although further long-term randomized trials are warranted, surgeons need to be cautious when choosing a bioprosthetic valve for patients undergoing SAVR.
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Affiliation(s)
- Yujiro Yokoyama
- Department of Surgery, St. Luke's University Health Network, Fountain Hill, Pennsylvania, USA
| | - Toshiki Kuno
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York City, New York, USA.,Department of Cardiology, Montefiore Medical Center/Albert Einstein Medical College, New York City, New York, USA
| | - Hisato Takagi
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
| | - Shinichi Fukuhara
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA
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Choi CH, Cao K, Malaver D, Kincaid EH, Lata A, Kon N, Belford PM, Gandhi SK, Applegate RJ, Zhao DXM. Redo-aortic valve replacement in prior stentless prosthetic aortic valves: Transcatheter versus surgical approach. Catheter Cardiovasc Interv 2021; 99:181-192. [PMID: 34402588 DOI: 10.1002/ccd.29921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 03/24/2021] [Accepted: 08/05/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The objective was to compare outcomes of redo-aortic valve replacement (AVR) via surgical or transcatheter approach in prior surgical AVR with large percentage of prior stentless surgical AVR. BACKGROUND With the introduction of transcatheter aortic valve replacement (TAVR), patients with increased surgical risks now have an alternative to redo surgical AVR (SAVR), known as valve-in-valve (ViV) TAVR. Stentless prosthetic aortic valves present a more challenging implantation for ViV-TAVR given the lack of structural frame. METHODS We performed a retrospective study of 173 subjects who have undergone SAVR (N = 100) or ViV-TAVR (N = 73) in patients with prior surgical AVR at Wake Forest Baptist Medical Center from 2009 to 2019. Our study received the proper ethical oversight. RESULTS The average ages in redo-SAVR and ViV-TAVR groups were 58.03 ± 13.86 and 66.57 ± 13.44 years, respectively (p < 0.0001). The redo-SAVR had significantly lower STS (2.78 ± 2.09 and 4.68 ± 5.51, p < 0.01) and Euroscores (4.32 ± 2.98 and 7.51 ± 8.24, p < 0.05). The redo-SAVR group had higher percentage requiring mechanical support (8% vs. 0%, p < 0.05) and vasopressors (53% vs. 0%, p < 0.0001), longer length of stay (13.65 ± 11.23 vs. 5.68 ± 7.64 days, p < 0.0001), and inpatient mortality (16% vs. 2.78%, p < 0.005). At 30-day follow-up, redo-SAVR group had higher rates of acute kidney injury (10% vs. 0%, p < 0.01), however ViV-TAVR group had more new left bundle branch blocks (6.85% vs. 0%, p < 0.05). No significant differences regarding re-hospitalization rates, stroke, or death up to 1-year. CONCLUSION Although the ViV-TAVR group had higher risk patients, there were significantly fewer procedural complications, shorter length of stay, and similar mortality outcomes up to 1-year follow-up.
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Affiliation(s)
- Charles H Choi
- Section of Cardiovascular Medicine, Wake Forest School of Medicine, Wake Forest Baptist Health System, Winston-Salem, North Carolina, USA.,Department of Internal Medicine, Wake Forest School of Medicine, Wake Forest Baptist Health System, Winston-Salem, North Carolina, USA
| | - Kevin Cao
- Department of Internal Medicine, Wake Forest School of Medicine, Wake Forest Baptist Health System, Winston-Salem, North Carolina, USA
| | - Diego Malaver
- Section of Cardiovascular Medicine, Wake Forest School of Medicine, Wake Forest Baptist Health System, Winston-Salem, North Carolina, USA.,Department of Internal Medicine, Wake Forest School of Medicine, Wake Forest Baptist Health System, Winston-Salem, North Carolina, USA
| | - Edward H Kincaid
- Department of Cardiothoracic Surgery, Wake Forest School of Medicine, Wake Forest Baptist Health System, Winston-Salem, North Carolina, USA
| | - Adrian Lata
- Department of Cardiothoracic Surgery, Wake Forest School of Medicine, Wake Forest Baptist Health System, Winston-Salem, North Carolina, USA
| | - Neal Kon
- Department of Cardiothoracic Surgery, Wake Forest School of Medicine, Wake Forest Baptist Health System, Winston-Salem, North Carolina, USA
| | - P Matthew Belford
- Section of Cardiovascular Medicine, Wake Forest School of Medicine, Wake Forest Baptist Health System, Winston-Salem, North Carolina, USA.,Department of Internal Medicine, Wake Forest School of Medicine, Wake Forest Baptist Health System, Winston-Salem, North Carolina, USA
| | - Sanjay K Gandhi
- Section of Cardiovascular Medicine, Wake Forest School of Medicine, Wake Forest Baptist Health System, Winston-Salem, North Carolina, USA.,Department of Internal Medicine, Wake Forest School of Medicine, Wake Forest Baptist Health System, Winston-Salem, North Carolina, USA
| | - Robert J Applegate
- Section of Cardiovascular Medicine, Wake Forest School of Medicine, Wake Forest Baptist Health System, Winston-Salem, North Carolina, USA.,Department of Internal Medicine, Wake Forest School of Medicine, Wake Forest Baptist Health System, Winston-Salem, North Carolina, USA
| | - David X M Zhao
- Section of Cardiovascular Medicine, Wake Forest School of Medicine, Wake Forest Baptist Health System, Winston-Salem, North Carolina, USA.,Department of Internal Medicine, Wake Forest School of Medicine, Wake Forest Baptist Health System, Winston-Salem, North Carolina, USA
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Khazaal J, Ragagni M, Parker J, Timek T, Murphy E, Heiser J, Willekes C. Freestyle Aortic Bioprostheses in Patients 60 Years old and Younger. Semin Thorac Cardiovasc Surg 2021; 34:870-877. [PMID: 34380081 DOI: 10.1053/j.semtcvs.2021.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 08/02/2021] [Indexed: 11/11/2022]
Abstract
Evaluate outcomes of the Freestyle stentless aortic bioprosthesis in patients 60 years old and younger. All patients, 60 years old and younger, between January 1, 1998 to December 31, 2015 who underwent implantation of a Freestyle aortic valve at a single institution were reviewed. Medical records and telephone interviews were utilized for data collection. 515 patients were identified with an average age of 51.3 years. Mean follow up was 11.1 years. 225 full root replacements and 290 subcoronary implants were performed. Overall survival, including patients with concomitant procedures, at 15 years was 63.7% (95% CI 58.3-68.5). Isolated subcoronary implants (58%,167/290) had a 15-year survival of 71.6% (95% CI 62.6-78.7) vs 78.4% (95% CI 69.7, 84.9) for isolated root replacements (63%,141/225) which was not statistically significant (P = 0.397). No significant difference in operative SVD at 15 years occurred between full root replacements 37.6% (95% CI 27.2-50.2) vs subcoronary implants 39.4% (95% CI31.1, 49.0). 110 patients required reoperation solely for intrinsic SVD. 93% (102/110) failed due to aortic insufficiency. Of reoperative interventions for SVD, 37% (41/110) of patients required urgent reoperation and 4.5% (5/110) required emergent reoperation. Pseudoaneurysms developed in six of the full root replacements. Freestyle aortic valves have a high rate of acute failure requiring urgent or emergent reintervention in patients 60 years old and younger. This has led our group to shift practice away from their implantation.
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Affiliation(s)
- Jawad Khazaal
- College of Human Medicine, Michigan State University, Grand Rapids
| | - Mary Ragagni
- Department of Cardiovascular Research, Spectrum Health, Grand Rapids
| | - Jessica Parker
- Office of Research and Education, Spectrum Health, Grand Rapids
| | - Tomasz Timek
- Department of Cardiothoracic Surgery, Spectrum Health, Grand Rapids
| | - Edward Murphy
- Department of Cardiothoracic Surgery, Spectrum Health, Grand Rapids
| | - John Heiser
- Department of Cardiothoracic Surgery, Spectrum Health, Grand Rapids
| | - Charles Willekes
- Department of Cardiothoracic Surgery, Spectrum Health, Grand Rapids.
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Paravalvular Leak After Transcatheter Aortic Valve Implantation Its Incidence, Diagnosis, Clinical Implications, Prevention, Management, and Future Perspectives: A Review Article. Curr Probl Cardiol 2021; 47:100957. [PMID: 34364915 DOI: 10.1016/j.cpcardiol.2021.100957] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 07/30/2021] [Indexed: 02/05/2023]
Abstract
Paravalvular leak (PVL) is very common after TAVI and has been reported to have a negative impact on both short- and long-term survival. The current study identified incidence, diagnosis, clinical implications, and prevention, management and future perspectives for post-TAVI paravalvular leak. A systematic literature search was conducted using PubMed and EMBASE, using the MeSH terms and key words "paravalvular leak," "diagnostic criteria," "implication," "influencing factors," and "prevention strategies." Studies were retained for review after meeting strict inclusion criteria that included only prospective studies evaluating Paravalvular leak in patients who had TAVI. Thirty articles were selected for inclusion, incidence of PVL across the studies ranged from 7% to 40%. Many factors have been associated with incidence and increased risk of PVL, including AVC volume, larger annulus dimensions, pre-TAVI transvalvular peak velocity, under sizing of the prosthesis, surgical, and other factors. PVL after TAVI is common and can be predicted by aortic root calcification volume, larger annulus dimensions, and pre-TAVI transvalvular peak velocity, with calcification volume being an independent predictor for PVL. The strength and nature of the association of various degrees of post-TAVI PVL and mortality are still to be further evaluated.
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Patel PM, Chiou E, Cao Y, Binongo J, Guyton RA, Leshnower B, Grubb KJ, Chen EP. Isolated Redo Aortic Valve Replacement Versus Valve-in-Valve Transcatheter Valve Replacement. Ann Thorac Surg 2021; 112:539-545. [DOI: 10.1016/j.athoracsur.2020.08.048] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 07/25/2020] [Accepted: 08/31/2020] [Indexed: 01/08/2023]
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Bhushan S, Huang X, Li Y, He S, Mao L, Hong W, Xiao Z. Paravalvular Leak After Transcatheter Aortic Valve Implantation Its Incidence, Diagnosis, Clinical Implications, Prevention, Management, and Future Perspectives: A Review Article. Curr Probl Cardiol 2021. [DOI: https://doi.org/10.1016/j.cpcardiol.2021.100957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Coti I, Maierhofer U, Rath C, Werner P, Loewe C, Kocher A, Laufer G, Andreas M. Effect of conventional and rapid-deployment aortic valve replacement on the distance from the aortic annulus to coronary arteries. Interact Cardiovasc Thorac Surg 2021; 32:196-203. [PMID: 33236042 DOI: 10.1093/icvts/ivaa247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 08/25/2020] [Accepted: 09/27/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This study aimed to compare the effect of surgical aortic valve replacement (SAVR) on coronary height in patients undergoing SAVR with rapid-deployment or SAVR with several standard sutured bioprostheses. This study may identify patients at higher risk of coronary obstruction during valve-in-valve procedures. METHODS We analysed 112 patients [mean age 71 (9 SD) years] who underwent SAVR with either a rapid-deployment aortic bioprosthesis (EDWARDS INTUITY Elite Valve) or other standard sutured biological valves. The coronary heights were assessed by computed tomography scan with the Philips 3D HeartNavigator system. RESULTS Two groups of patients were analysed: 51 (45.5%) patients implanted with an RD-AVR, which is a supra-annular valve that requires 3 anchoring sutures without the use of pledgets, and 61 (54.5%) patients implanted with a conventional supra-annular sutured bioprosthesis. The mean right and left coronary artery-to-annulus (RCAA and LCAA) heights at baseline were 16.9 (4.6 SD) and 14.2 (4.0 SD) mm in the standard sutured group and 16.3 (3.5 SD) and 12.8 (2.9 SD) mm in the RD-AVR group, respectively; a significantly shorter distance was observed for the left coronary artery in the rapid-deployment group (P = 0.420 for RCAA height and P = 0.044 for LCAA). Postoperatively, the mean RCAA and LCAA heights were significantly decreased in both groups compared to baseline. A mean of 11.5 (4.8 SD) mm for the RCAA and 7.9 (4.3 SD) mm for the LCAA in the standard sutured group as well as 14.4 (3.9 SD) mm for the RCAA and 9.0 (3.1 SD) mm for the LCAA in the RD-AVR group were observed (P < 0.001 for RCAA and LCAA in both the sutured and rapid-deployment groups). Despite the significant difference in the mean distance from the left coronary artery to annulus between the groups at baseline, the postoperative mean distance of the LCAA to the sewing ring was still higher in the RD-AVR group. CONCLUSIONS A significantly shorter coronary artery-to-aortic annulus distance for both the right and left main coronary arteries was observed after AVR with different conventional sutured supra-annular bioprostheses compared to AVR with rapid-deployment valves. These findings might be relevant for bioprosthesis selection, especially for young patients.
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Affiliation(s)
- Iuliana Coti
- Division of Surgery, Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Udo Maierhofer
- Division of Surgery, Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Claus Rath
- Division of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | - Paul Werner
- Division of Surgery, Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Christian Loewe
- Division of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Alfred Kocher
- Division of Surgery, Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Guenther Laufer
- Division of Surgery, Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Martin Andreas
- Division of Surgery, Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
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François K, De Backer L, Martens T, Philipsen T, Van Belleghem Y, Bové T. Repeat aortic valve surgery: contemporary outcomes and risk stratification. Interact Cardiovasc Thorac Surg 2021; 32:213-221. [PMID: 33279996 DOI: 10.1093/icvts/ivaa257] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/25/2020] [Accepted: 09/16/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Redo aortic valve surgery (rAVS) is performed with increasing frequency, but operative mortality is usually higher compared to that associated with primary aortic valve surgery. We analysed our patients who had rAVS to determine the current outcomes of rAVS as a surgical benchmark in view of the growing interest in transcatheter valve techniques. METHODS We retrospectively reviewed 148 consecutive patients [median age 67.7 years (interquartile range 54.9-77.6); 68.2% men] who underwent rAVS following aortic valve replacement (81.6%), aortic root replacement (15%) or aortic valve repair (3.4%) between 2000 and 2018. RESULTS Indications for rAVS were structural valve dysfunction (42.7%), endocarditis (37.8%), non-structural valve dysfunction (17.7%) and aortic aneurysm (2.1%). Valve replacement was performed in 69.7%, and 34 new root procedures were necessary in 23%. Early mortality was 9.5% (n = 14). Female gender [odds ratio (OR) 6.16], coronary disease (OR 4.26) and lower creatinine clearance (OR 0.95) were independent predictors of early mortality. Follow-up was 98.6% complete [median 5.9 (interquartile range 1.7-10.9) years]. Survival was 74.1 ± 3.7%, 57.9 ± 5.1% and 43.8 ± 6.1% at 5, 10 and 14 years, respectively. Cox regression analysis revealed female gender [hazard ratio (HR) 1.73], diabetes (HR 1.73), coronary disease (HR 1.62) and peripheral vascular disease (HR 1.98) as independent determinants of late survival. CONCLUSIONS Despite many urgent situations and advanced New York Heart Association functional class at presentation, rAVS could be performed with acceptable early and late outcomes. Risk factors for survival were female gender, coronary disease and urgency. In this all-comers patient cohort needing rAVS, only a minority would eventually qualify for transcatheter valve-in-valve procedures.
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Affiliation(s)
- Katrien François
- Department of Cardiac Surgery, University Hospital Ghent, Gent, Belgium
| | - Laurent De Backer
- University Ghent, Faculty of Medicine and Health Sciences, Gent, Belgium
| | - Thomas Martens
- Department of Cardiac Surgery, University Hospital Ghent, Gent, Belgium
| | - Tine Philipsen
- Department of Cardiac Surgery, University Hospital Ghent, Gent, Belgium
| | | | - Thierry Bové
- Department of Cardiac Surgery, University Hospital Ghent, Gent, Belgium
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Ciardetti N, Ciatti F, Nardi G, Di Muro FM, Demola P, Sottili E, Stolcova M, Ristalli F, Mattesini A, Meucci F, Di Mario C. Advancements in Transcatheter Aortic Valve Implantation: A Focused Update. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:711. [PMID: 34356992 PMCID: PMC8306774 DOI: 10.3390/medicina57070711] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/09/2021] [Accepted: 07/12/2021] [Indexed: 01/07/2023]
Abstract
Transcatheter aortic valve implantation (TAVI) has become the leading technique for aortic valve replacement in symptomatic patients with severe aortic stenosis with conventional surgical aortic valve replacement (SAVR) now limited to patients younger than 65-75 years due to a combination of unsuitable anatomies (calcified raphae in bicuspid valves, coexistent aneurysm of the ascending aorta) and concerns on the absence of long-term data on TAVI durability. This incredible rise is linked to technological evolutions combined with increased operator experience, which led to procedural refinements and, accordingly, to better outcomes. The article describes the main and newest technical improvements, allowing an extension of the indications (valve-in-valve procedures, intravascular lithotripsy for severely calcified iliac vessels), and a reduction of complications (stroke, pacemaker implantation, aortic regurgitation).
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Carlo Di Mario
- Structural Interventional Cardiology, Department of Clinical and Experimental Medicine, Clinica Medica, Room 124, Careggi University Hospital, Largo Brambilla 3, 50139 Florence, Italy; (N.C.); (F.C.); (G.N.); (F.M.D.M.); (P.D.); (E.S.); (M.S.); (F.R.); (A.M.); (F.M.)
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Gallo M, Sá MPBO, Doulamis IP, Hussein N, Laforgia PL, Kampaktsis PN, Tagliari AP, Ferrari E. Transcatheter valve-in-valve implantation for degenerated bioprosthetic aortic and mitral valves - an update on indications, techniques, and clinical results. Expert Rev Med Devices 2021; 18:597-608. [PMID: 34080501 DOI: 10.1080/17434440.2021.1939009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Introduction: Aortic and mitral bioprosthesis are the gold standard treatment to replace a pathological native valve. However, bioprostheses are prone to structural valve degeneration, resulting in limited long-term durability. During the past decade, the implantation of transcatheter stent-valves within degenerated aortic and mitral bioprostheses, (the so-called 'valve-in-valve' procedure), represents a valid alternative to redo surgery in patients with high-risk surgical profiles.Areas covered: We reviewed the clinical outcomes and the procedural details of transcatheter aortic and mitral valve-in-valve series according to current published literature and include a practical guide for valve sizing and stent-valve positioning and strategies to prevent complications.Expert opinion: In both aortic and mitral positions meticulous planning is fundamental in these procedures to avoid serious complications including patient prosthesis mismatch, coronary obstruction and left ventricular outflow tract obstruction.
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Affiliation(s)
- Michele Gallo
- Cardiovascular Surgery, Cardiocentro Ticino Institute, Lugano, Switzerland
| | - Michel Pompeu B O Sá
- Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco PROCAPE, University of Pernambuco-UPE, Recife, Brazil
| | - Ilias P Doulamis
- Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nabil Hussein
- Department of Congenital Cardiac Surgery, Yorkshire Heart Centre, Leeds General Infirmary, England, UK
| | - Pietro L Laforgia
- Department of Cardiology, Institut Cardiovasculaire Paris Sud, Massy, France
| | | | - Ana Paula Tagliari
- Postgraduate Program in Health Sciences: Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Enrico Ferrari
- Cardiovascular Surgery, Cardiocentro Ticino Institute, Lugano, Switzerland
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Qi SS, Kelly RF, Bianco R, Schoen FJ. Increased utilization of bioprosthetic aortic valve technology:Trends, drivers, controversies and future directions. Expert Rev Cardiovasc Ther 2021; 19:537-546. [PMID: 33928833 DOI: 10.1080/14779072.2021.1924676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Introduction: Bioprosthetic valves (BPV) implanted surgically or by transcatheter valve implantation (TAVI) comprise an overwhelming majority of substitute aortic valves implanted worldwide.Areas Covered: Prominent drivers of this trend are: 1) BPV patients have generally better outcomes than those with a mechanical valve, and remain largely free of anticoagulation and its consequences; 2) BPV durability has improved over the years; and 3) the expanding use of TAVI and valve-in-valve (VIV) procedures permitting interventional management of structural valve degeneration (SVD). Nevertheless, key controversies exist: 1) optimal anticoagulation regimens for surgical and TAVI BPVs; 2) the incidence, mechanisms and mitigation strategies for SVD; 3) the use of VIV for treatment of SVD, and 4) valve selection recommendations for difficult cohorts, (e.g. patients 50-70 years, patients <50, childbearing age women). This communication reviews trends in and drivers of BPV utilization, current controversies, and future directions affecting BPV use.Expert Opinion: Long-term data are needed in several areas related to aortic BPV use, including anticoagulation/antiplatelet therapy, especially following TAVI. TAVI and especially VIV durability and optimal use warrant will benefit greatly from long-term data. Certain populations may benefit from such high-quality data on multi-year outcomes, particularly younger patients.
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Affiliation(s)
- Steven S Qi
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Rosemary F Kelly
- Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Richard Bianco
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Frederick J Schoen
- Professor of Pathology and Health Sciences and Technology, Harvard Medical School, Executive Vice Chairman, Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
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Jin XY, Petrou M, Hu JT, Nicol ED, Pepper JR. Challenges and opportunities in improving left ventricular remodelling and clinical outcome following surgical and trans-catheter aortic valve replacement. Front Med 2021; 15:416-437. [PMID: 34047933 DOI: 10.1007/s11684-021-0852-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 02/20/2021] [Indexed: 11/26/2022]
Abstract
Over the last half century, surgical aortic valve replacement (SAVR) has evolved to offer a durable and efficient valve haemodynamically, with low procedural complications that allows favourable remodelling of left ventricular (LV) structure and function. The latter has become more challenging among elderly patients, particularly following trans-catheter aortic valve implantation (TAVI). Precise understanding of myocardial adaptation to pressure and volume overloading and its responses to valve surgery requires comprehensive assessments from aortic valve energy loss, valvular-vascular impedance to myocardial activation, force-velocity relationship, and myocardial strain. LV hypertrophy and myocardial fibrosis remains as the structural and morphological focus in this endeavour. Early intervention in asymptomatic aortic stenosis or regurgitation along with individualised management of hypertension and atrial fibrillation is likely to improve patient outcome. Physiological pacing via the His-Purkinje system for conduction abnormalities, further reduction in para-valvular aortic regurgitation along with therapy of angiotensin receptor blockade will improve patient outcome by facilitating hypertrophy regression, LV coordinate contraction, and global vascular function. TAVI leaflet thromboses require anticoagulation while impaired access to coronary ostia risks future TAVI-in-TAVI or coronary interventions. Until comparable long-term durability and the resolution of TAVI related complications become available, SAVR remains the first choice for lower risk younger patients.
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Affiliation(s)
- Xu Yu Jin
- Surgical Echo-Cardiology Services, Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 9DU, UK.
- Cardiac Surgical Physiology and Genomics Group, Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of Medicine, University of Oxford, Oxford, OX3 9DU, UK.
| | - Mario Petrou
- Department of Cardiac Surgery, Royal Brompton Hospital, London, SW3 6NP, UK
- National Heart and Lung Institute, Imperial College London, London, SW3 6LY, UK
| | - Jiang Ting Hu
- Cardiac Surgical Physiology and Genomics Group, Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of Medicine, University of Oxford, Oxford, OX3 9DU, UK
| | - Ed D Nicol
- National Heart and Lung Institute, Imperial College London, London, SW3 6LY, UK
- Department of Cardiology, Royal Brompton Hospital, London, SW3 6NP, UK
| | - John R Pepper
- Department of Cardiac Surgery, Royal Brompton Hospital, London, SW3 6NP, UK
- National Heart and Lung Institute, Imperial College London, London, SW3 6LY, UK
- NIHR Imperial Biomedical Research Centre, London, W2 1NY, UK
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Charlesworth M, Williams BG, Buch MH. Advances in transcatheter aortic valve implantation, part 1: patient selection and preparation. BJA Educ 2021; 21:232-237. [PMID: 34026277 DOI: 10.1016/j.bjae.2021.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2021] [Indexed: 10/21/2022] Open
Affiliation(s)
- M Charlesworth
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - B G Williams
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - M H Buch
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
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Dokollari A, Cameli M, Mandoli GE, Kalra DKS, Poston R, Coku L, Pernoci M, Miri M, Bonacchi M, Gelsomino S. Early and Midterm Clinical Outcomes of Transcatheter Valve-in-Valve Implantation Versus Redo Surgical Aortic Valve Replacement for Aortic Bioprosthetic Valve Degeneration: Two Faces of the Same Medal. J Cardiothorac Vasc Anesth 2021; 35:3223-3231. [PMID: 34175205 DOI: 10.1053/j.jvca.2021.05.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 05/10/2021] [Accepted: 05/12/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To compare early and midterm outcomes of transcatheter valve-in-valve implantation (ViV-TAVI) and redo surgical aortic valve replacement (re-SAVR) for aortic bioprosthetic valve degeneration. DESIGN Patients who underwent ViV-TAVI and re-SAVR for aortic bioprosthetic valve degeneration between January 2010 and October 2018 were retrospectively analyzed. Mean follow-up was 3.0 years. SETTING In-hospital, early, and mid-term outcomes. PARTICIPANTS Eighty-eight patients were included in the analysis. INTERVENTIONS Thirty-one patients (37.3%) had ViV-TAVI, and 57 patients (62.7%) had re-SAVR. MEASUREMENTS AND MAIN RESULTS In the ViV-TAVI group, patients were older (79.1 ± 7.4 v 67.2 ± 14.1, p < 0.01). The total operative time, intubation time, intensive care unit length of stay, total hospital length of stay, inotropes infusion, intubation >24 hours, total amount of chest tube losses, red blood cell transfusions, plasma transfusions, and reoperation for bleeding were significantly higher in the re-SAVR cohort (p < 0.01). There was no difference regarding in-hospital permanent pacemaker implantation (ViV-TAVI = 3.2% v re-SAVR = 8.8%, p = 0.27), patient-prosthesis mismatch (ViV-TAVI = 12 patients [mean 0.53 ± 0.07] and re-SAVR = ten patients [mean 0.56 ± 0.08], p = 0.4), stroke (ViV-TAVI = 3.2% v re-SAVR = 7%, p = 0.43), acute kidney injury (ViV-TAVI = 9.7% v re-SAVR = 15.8%, p = 0.1), and all-cause infections (ViV-TAVI = 0% v re-SAVR = 8.8%, p = 0.02), between the two groups. In-hospital mortality was 0% and 7% for ViV-TAVI and re-SAVR, respectively (p = 0.08). At three-years' follow-up, the incidence of pacemaker implantation was higher in the re-SAVR group (ViV-TAVI = 0 v re-SAVR = 13.4%, p < 0.01). There were no differences in reintervention (ViV-TAVI = 3.8% v re-SAVR = 0%, p = 0.32) and survival (ViV-TAVI = 83.9% v re-SAVR = 93%, p = 0.10) between the two cohorts. CONCLUSIONS ViV-TAVI is a safe, feasible, and reliable procedure.
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Affiliation(s)
- Aleksander Dokollari
- Cardiac Surgery Department, Saint Michael's Hospital, Toronto, Canada; Cardiac Surgery, CARIM, Maastricht University Medical Center, Maastricht, Netherlands.
| | - Matteo Cameli
- Le Scotte Hospital, University of Siena, Siena, Italy
| | | | | | | | - Lindita Coku
- University of New Mexico School of Medicine, Albuquerque, NM
| | | | | | - Massimo Bonacchi
- Cardiac Surgery Unit, Department of Experimental and Clinical Medicine, University of Florence, Firenze, Italy
| | - Sandro Gelsomino
- Cardiac Surgery, CARIM, Maastricht University Medical Center, Maastricht, Netherlands
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Calcaterra D, Kaur N, Dasari G, Daniel G. A case report of open-aorta, direct transcatheter valve-in-valve implantation: an innovative approach to manage the hazard of coronary flow compromise in transcatheter aortic valve re-interventions. EUROPEAN HEART JOURNAL-CASE REPORTS 2021; 5:ytab137. [PMID: 34124562 PMCID: PMC8189306 DOI: 10.1093/ehjcr/ytab137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/07/2020] [Accepted: 04/06/2021] [Indexed: 11/16/2022]
Abstract
Background Coronary flow compromise is a significant risk of transcatheter aortic valve therapy. Warranting preservation of coronary flow is even more challenging with transcatheter aortic valve re-intervention since the implantation of a transcatheter valve within a degenerated bioprosthetic or transcatheter valve increases significantly this hazard. Case summary We present a case of heart failure secondary to transcatheter aortic valve degeneration requiring a transcatheter aortic valve re-intervention. Pre-operative imaging studies demonstrated a high risk for iatrogenic coronary flow impairment. The patient underwent a successful surgical removal of the prosthetic valve leaflets followed by direct transcatheter aortic valve implantation. Conclusion We reviewed the literature on the approach to difficult coronaries in transcatheter aortic valve therapy, and we describe an innovative hybrid approach that may represent a viable alternative in cases where catheter techniques of coronary flow preservation are not applicable.
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Affiliation(s)
- Domenico Calcaterra
- Division of Cardiothoracic Surgery, Department of Surgery, Bethesda Heart Hospital, Florida Atlantic University, 777 Glades Rd, Boca Raton, FL 33431, USA
| | - Navneet Kaur
- Division of Cardiology, Bethesda Heart Hospital, Florida Atlantic University, Boca Raton, FL, USA
| | - Gopika Dasari
- Division of Cardiology, Bethesda Heart Hospital, Florida Atlantic University, Boca Raton, FL, USA
| | - George Daniel
- Division of Cardiology, Bethesda Heart Hospital, Florida Atlantic University, Boca Raton, FL, USA
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Abstract
Aortic stenosis is the most common valvular disease requiring valve replacement. Valve replacement therapies have undergone progressive evolution since the 1960s. Over the last 20 years, transcatheter aortic valve replacement has radically transformed the care of aortic stenosis, such that it is now the treatment of choice for many, particularly elderly, patients. This review provides an overview of the pathophysiology, presentation, diagnosis, indications for intervention, and current therapeutic options for aortic stenosis.
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Affiliation(s)
- Marko T Boskovski
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA
| | - Thomas G Gleason
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA
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Ahmed A, Levy KH. Valve-in-valve transcatheter aortic valve replacement versus redo surgical aortic valve replacement: A systematic review and meta-analysis. J Card Surg 2021; 36:2486-2495. [PMID: 33797799 DOI: 10.1111/jocs.15546] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/09/2021] [Accepted: 03/22/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND/AIM With the growing contemporary use of bioprosthetic valves, whose limited long-term durability has been well-documented, an increase in the need for reintervention is expected. We perform a meta-analysis to compare the current standard of care, redo surgical aortic valve replacement (Redo SAVR) with the less invasive alternative, valve-in-valve transcatheter aortic valve replacement (ViV TAVR) for treating structural valve deterioration. METHODS After a comprehensive literature search, studies comparing ViV TAVR to Redo SAVR were pooled to perform a pairwise meta-analysis using the random-effects model. Primary outcomes were 30-day and follow-up mortality. RESULTS A total of nine studies including 9127 patients were included. ViV TAVR patients were significantly older (mean difference [MD], 5.82; p = .0002) and more frequently had hypercholesterolemia (59.7 vs. 60.0%; p = .0006), coronary artery disease (16.1 vs. 16.1%; p = .04), periphery artery disease (15.4 vs. 5.7%; p = .004), chronic obstructive pulmonary disease (29.3 vs. 26.2%; p = .04), renal failure (30.2 vs. 24.0%; p = .009), and >1 previous cardiac surgery (23.6 vs. 15.9%; p = .004). Despite this, ViV TAVR was associated with decreased 30-day mortality (OR, 0.56; p < .0001). Conversely, Redo SAVR had lower 30-day paravalvular leak (OR, 6.82; p = .04), severe patient-prosthesis mismatch (OR, 3.77; p < .0001), and postoperative aortic valve gradients (MD, 5.37; p < .0001). There was no difference in follow-up mortality (HR, 1.02; p = .86). CONCLUSIONS Despite having patients with an increased baseline risk, ViV TAVR was associated with lower 30-day mortality, while Redo SAVR had lower paravalvular leak, severe patient-prosthesis mismatch, and postoperative gradients. Although ViV TAVR remains a feasible treatment option in high-risk patients, randomized trials are necessary to elucidate its efficacy over Redo SAVR.
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Affiliation(s)
- Adham Ahmed
- CUNY School of Medicine, New York, New York, USA
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45
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Transcatheter valve-in-valve implantation for sutureless bioprosthetic aortic paravalvular leak in the era of COVID-19. Anatol J Cardiol 2021; 25:209-211. [PMID: 33690137 DOI: 10.14744/anatoljcardiol.2020.62884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Macherey S, Meertens M, Mauri V, Frerker C, Adam M, Baldus S, Schmidt T. Meta-Analysis of Stroke and Mortality Rates in Patients Undergoing Valve-in-Valve Transcatheter Aortic Valve Replacement. J Am Heart Assoc 2021; 10:e019512. [PMID: 33682426 PMCID: PMC8174195 DOI: 10.1161/jaha.120.019512] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background During the past decade, the use of transcatheter aortic valve replacement (TAVR) was extended beyond treatment‐naïve patients and implemented for treatment of degenerated surgical bioprosthetic valves. Selection criteria for either valve‐in‐valve (viv) TAVR or redo surgical aortic valve replacement are not well established, and decision making on the operative approach still remains challenging for the interdisciplinary heart team. Methods and Results This review was intended to analyze all studies on viv‐TAVR focusing on short‐ and mid‐term stroke and mortality rates compared with redo surgical aortic valve replacement or native TAVR procedures. A structured literature search and review process led to 1667 potentially relevant studies on July 1, 2020. Finally, 23 studies fulfilled the inclusion criteria for qualitative analysis. All references were case series either with or without propensity score matching and registry analyses. Quantitative synthesis of data from 8509 patients revealed that viv‐TAVR is associated with mean 30‐day stroke and mortality rates of 2.2% and 4.2%, respectively. Pooled data analysis showed no significant differences in 30‐day stroke rate, 30‐day mortality, and 1‐year mortality between viv‐TAVR and comparator treatment (native TAVR [n=11 804 patients] or redo surgical aortic valve replacement [n=498 patients]). Conclusions This review is the first one comparing the risk for stroke and mortality rates in viv‐TAVR procedures with native TAVR approach and contributes substantial data for the clinical routine. Moreover, this systematic review is the most comprehensive analysis on ischemic cerebrovascular events and early mortality in patients undergoing viv‐TAVR. In this era with increasing numbers of bioprosthetic valves used in younger patients, viv‐TAVR is a suitable option for the treatment of degenerated bioprostheses.
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Affiliation(s)
- Sascha Macherey
- Department III of Internal Medicine University Hospital of Cologne Cologne Germany
| | - Max Meertens
- Department III of Internal Medicine University Hospital of Cologne Cologne Germany
| | - Victor Mauri
- Department III of Internal Medicine University Hospital of Cologne Cologne Germany
| | - Christian Frerker
- Department III of Internal Medicine University Hospital of Cologne Cologne Germany
| | - Matti Adam
- Department III of Internal Medicine University Hospital of Cologne Cologne Germany
| | - Stephan Baldus
- Department III of Internal Medicine University Hospital of Cologne Cologne Germany
| | - Tobias Schmidt
- Department III of Internal Medicine University Hospital of Cologne Cologne Germany
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Stankowski T, Mangner N, Linke A, Aboul-Hassan SS, Gąsior T, Muehle A, Herwig V, Harnath A, Salem M, Szłapka M, Grimmig O, Just S, Fritzsche D, Perek B. Cardiac conduction abnormalities in patients with degenerated bioprostheses undergoing transcatheter aortic valve-in-valve implantations and their impact on long-term outcomes. Int J Cardiol 2021; 330:16-22. [PMID: 33592238 DOI: 10.1016/j.ijcard.2021.02.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/08/2021] [Accepted: 02/10/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND The relationship between preoperative cardiac conduction abnormalities (CCA) and long-term outcomes after transcatheter aortic valve-in-valve implantation (TAVI-VIV) remains unclear. The aim of the study was to evaluate the effects of preoperative CCA on mortality and morbidity after TAVI-VIV and to estimate the impact of new-onset CCA on postoperative outcomes. METHODS Between 2011 and 2020, 201 patients with degenerated aortic bioprostheses were qualified for TAVI-VIV procedures in two German heart centers. Cases with previously implanted permanent rhythm-controlling devices were excluded (n = 53). A total of 148 subjects met the eligibility criteria and were divided into 2 study groups according to the presence of preexisting CCA (CCA (n = 84) and non-CCA (n = 64), respectively). Early and late mortality and morbidity were evaluated. Follow-up functional status was assessed according to New York Heart Association (NYHA) classification. RESULTS There were no procedural deaths. TAVI-VIV related new-onset CCAs were observed in 35.8% patients. The 30-day permanent pacemaker implantation rate was 1.6% in non-CCA vs 9.5% in CCA group (p = 0.045). Preexisting right bundle-branch block (OR:5.01; 95%CI, 1.05-23.84) and first-degree atrioventricular block (OR:4.55; 95%CI, 1.10-18.73) were independent predictors of new pacemaker implantation. One-year and five-year probability of survival were comparable in CCA and non-CCA groups: 90.3% vs 91.8% and 68.2% vs 74.3%, respectively. Surviving patients with preexisting and new-onset CCA had a worse functional status according to NYHA classification at follow-up. CONCLUSION Preexisting and new-onset postoperative CCAs did not affect early and late mortality after TAVI-VIV procedures, however, they may have a negative impact on late functional status.
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Affiliation(s)
- Tomasz Stankowski
- Sana Heart Center Cottbus, Department of Cardiac Surgery, Cottbus, Germany.
| | - Norman Mangner
- Herzzentrum Dresden, Technische Universität Dresden, Department of Internal Medicine and Cardiology, Dresden, Germany
| | - Axel Linke
- Herzzentrum Dresden, Technische Universität Dresden, Department of Internal Medicine and Cardiology, Dresden, Germany
| | | | - Tomasz Gąsior
- Herzzentrum Dresden, Technische Universität Dresden, Department of Internal Medicine and Cardiology, Dresden, Germany
| | - Anja Muehle
- Sana Heart Center Cottbus, Department of Cardiac Surgery, Cottbus, Germany
| | - Volker Herwig
- Sana Heart Center Cottbus, Department of Cardiac Surgery, Cottbus, Germany
| | - Axel Harnath
- Sana Heart Center Cottbus, Department of Cardiac Surgery, Cottbus, Germany
| | - Mohammed Salem
- Department of Cardiology, Carl-Thiem-Klinikum, Cottbus, Germany
| | - Michał Szłapka
- Department of Cardiac Surgery, Asklepios Klinik Harburg, Hamburg, Germany
| | - Oliver Grimmig
- Sana Heart Center Cottbus, Department of Cardiac Surgery, Cottbus, Germany
| | - Soeren Just
- Sana Heart Center Cottbus, Department of Cardiac Surgery, Cottbus, Germany
| | - Dirk Fritzsche
- Sana Heart Center Cottbus, Department of Cardiac Surgery, Cottbus, Germany
| | - Bartłomiej Perek
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland
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Khokhar AA, Laricchia A, Ponticelli F, Kim WK, Gallo F, Regazzoli D, Toselli M, Sticchi A, Ruggiero R, Cereda A, Zlahoda-Huzior A, Fisicaro A, Gardi I, Mangieri A, Reimers B, Dudek D, Colombo A, Giannini F. Computed tomography analysis of coronary ostia location following valve-in-valve transcatheter aortic valve replacement with the ACURATE neo valve: Implications for coronary access. Catheter Cardiovasc Interv 2021; 98:595-604. [PMID: 33586278 DOI: 10.1002/ccd.29503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 12/10/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) is an emerging alternative to re-do surgery. However, the challenge of coronary access (CA) following ViV-TAVR is a potential limitation as TAVR expands to younger lower-risk populations. OBJECTIVES Using post-implantation computed tomography (CT) scans to evaluate the geometrical relationship between coronary ostia and valve frame in patients undergoing ViV-TAVR with the ACURATE neo valve. METHODS Post-implant CT scans of 18 out of 20 consecutive patients treated with the ACURATE neo valve were analyzed. Coronary ostia location in relation to the highest plane (HP) (highest point of the ACURATE neo or surgical valve) was determined. Ostia located below the highest plan were further subclassified according to the gap available between the transcatheter heart valve frame and ostium (transcatheter-to-coronary [TTC] distance). The impact implantation depth has on these geometrical relationships was evaluated. RESULTS A total of 21 out of 36 coronary ostia (58%) were located below the level of the HP with the left coronary artery (36%) more likely to be affected than the right (22%). Further sub-classification of these ostia revealed a large (>6 mm), moderate (4-6 mm), and small (<4 mm) TTC distance in 57% (12/21), 38% (8/21), and in 6% (1/18) of cases, respectively. At an implantation depth <4 mm compared to >4 mm, all ostia were located below the HP with no difference in post-procedural mean gradients (14.5 mmHg ± 4.7 vs. 12.6 mmHg ± 5.8; p = .5, 95%CI 3.8-7.5). CONCLUSIONS CA following ACURATE neo implantation for ViV-TAVR could potentially be challenging in a significant proportion of patients and specific consideration should be given to the implantation depth.
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Affiliation(s)
- Arif A Khokhar
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Alessandra Laricchia
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Francesco Ponticelli
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Won-Keun Kim
- Department of Cardiology and Cardiac Surgery, Kerckhoff Heart and Lung Center, Bad Nauheim, Germany
| | - Francesco Gallo
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | | | - Marco Toselli
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Alessandro Sticchi
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Rossella Ruggiero
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Alberto Cereda
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Adriana Zlahoda-Huzior
- Department of Measurement and Electronics, Poland and AGH University of Science and Technology, Krakow, Poland
| | - Andrea Fisicaro
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Ilja Gardi
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Antonio Mangieri
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | | | - Dariusz Dudek
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Antonio Colombo
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Francesco Giannini
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
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49
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Teixeira P, Ferreira W, Pires-Morais G, Rodrigues A, Braga P. Valve-in-Valve Transcatheter Aortic Valve Implantation Using Fluoroscopic Guidance for Late Failure of the Bioprosthetic Bentall Conduit BioValsalva™ Vascutek. Cureus 2020; 12:e12006. [PMID: 33437554 PMCID: PMC7793471 DOI: 10.7759/cureus.12006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We describe one of the first-in-human cases of valve-in-valve transcatheter aortic valve implantation (TAVI) using fluoroscopic-only guidance for the treatment of late failure of a bio-prosthetic Bentall conduit, the BioValsalva™ Vascutek (Vascutek Terumo, Renfrewshire, Scotland), using a self-expandable heart valve prosthesis (CoreValve™ Evolut™ R, Medtronic, Dublin Ireland).
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Affiliation(s)
- Pedro Teixeira
- Cardiology, Centro Hospitalar de Vila Nova de Gaia / Espinho, Vila Nova de Gaia, PRT
| | - Wilson Ferreira
- Cardiology, Centro Hospitalar de Vila Nova de Gaia / Espinho, Vila Nova de Gaia, PRT
| | - Gustavo Pires-Morais
- Cardiology, Centro Hospitalar de Vila Nova de Gaia / Espinho, Vila Nova de Gaia, PRT
| | - Alberto Rodrigues
- Cardiology, Centro Hospitalar de Vila Nova de Gaia / Espinho, Vila Nova De Gaia, PRT
| | - Pedro Braga
- Cardiology, Centro Hospitalar de Vila Nova de Gaia / Espinho, Vila Nova de Gaia, PRT
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50
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Randall MH, Lewandowski TJ, Choi C, Beaver TM. Valve-in-valve transcatheter aortic valve replacement to treat multijet paravalvular regurgitation: A case series and review. Clin Cardiol 2020; 44:13-19. [PMID: 33216400 PMCID: PMC7803366 DOI: 10.1002/clc.23504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/22/2020] [Accepted: 10/25/2020] [Indexed: 02/06/2023] Open
Abstract
Treatment advances for severe symptomatic aortic stenosis including transcatheter and open surgical valve replacement have improved patient survival, length of stay, and speed to recovery. However, paravalvular regurgitation (PVR) is occasionally seen and when moderate or greater in severity is associated with an at least 2-fold increase in 1 year mortality. While several treatment approaches focused on single-jet PVR have been described in the literature, few reports describe multijet PVR. Multijet PVR can successfully be treated with a variety of catheter-based options including valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR). We present two patients with at least moderate PVR following aortic valve replacement who were successfully treated with ViV TAVR along with a review of literature highlighting our rationale for utilizing each management approach. Multijet PVR can be treated successfully with ViV TAVR, but additional options such as self-expanding occluder devices and bioprosthetic valve fracture have a role as adjunctive treatments to achieve optimal results. The etiology of multijet PVR can differ between patients, this heterogeneity underscores the paucity of data to guide treatment strategies. Therefore, successful treatment of multijet PVR requires familiarity with available therapeutic options to achieve optimal results and, by extension, decrease patient mortality.
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Affiliation(s)
- Morgan H Randall
- Department of Medicine, Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida, USA
| | - Thomas J Lewandowski
- Department of Medicine, Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida, USA
| | - Calvin Choi
- North Florida/South Georgia Veterans Health System, Medical Service, Cardiology Section Gainesville, Gainesville, Florida, USA
| | - Thomas M Beaver
- Department of Surgery, Division of Thoracic and Cardiovascular Surgery, University of Florida, Gainesville, Florida, USA
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